J Harvey, et. al., Improved survival in matched unrelated donor transplant for childhood ALL since the introduction of high-resolution matching at HLA class I and II, Bone Marrow Transplantation 47, 1294 (2012)
We present the first detailed study analysis OS(Omenn Syndrome) in BMT(Bone Marrow Transplantation) for paediatric ALL(Acute Lymphoblastic Leukemia) following the introduction of high-resolution (HR) HLA matching. A total of 356 consecutive paediatric ALL stem cell transplants performed between 1988 and 2007 were reviewed; 80 of them were performed following the introduction of HR HLA class I and class II matching to the transplant programme in 2002. Comparisons of matched unrelated donor (MUD) transplant outcomes before and after this period were made. Matching at the HR level for HLA-A, -B, -C, -DRB1 and -DQB1 (HR-MUD) correlated with a greater than 25% improvement in 2- and 5-year OS in paediatric ALL patients transplanted with MUDs (P=0.009, P=0.005, respectively). Two-year OS for contemporaneous HLA-matched sibling transplants (80.8%) and HR-MUD transplants (78.8%) was equivalent. At 6%, non-relapse mortality (NRM) in MUD transplants since 2002 was significantly reduced compared with previous epochs.
The results in this study support the concept that donor selection guidelines for HLA matching in unrelated donor stem cell transplants for paediatric ALL transplants, where an unrelated BM or PBSC transplant is to be performed should require HR HLA typing and matching of donor and recipient at HLA-A, -B, -C, -DRB1 and -DQB1.