Incidence, risk factors and clinical outcome of leukemia relapses with loss of the mismatched HLA after partially incompatible hematopoietic stem cell transplantation.

摘要: Genomic loss of the mismatched human leukocyte antigen (HLA) is a recently described mechanism leukemia immune escape and relapse after allogeneic hematopoietic stem cell transplantation (HSCT). Here we first evaluated its incidence, risk factors outcome in 233 consecutive transplants from partially HLA-mismatched related unrelated donors (MMRD MMUD, respectively). We documented 84 relapses, 23 which with HLA loss. All relapses occurred MMRD HSCT, 20/23 patients acute myeloid leukemia. Upon variants accounted for 33% (23/69), occurring later than their 'classical' counterparts (median: 307 vs 88 days, P<0.0001). Active disease at HSCT increased (hazard ratio (HR): 10.16; confidence interval (CI): 2.65-38.92; P=0.001), whereas older patient ages had protective role (HR: 0.16; CI: 0.05-0.46; P=0.001). A weaker association was observed graft T-cell dose occurrence chronic graft-versus-host disease. Outcome similarly poor, second different donor appeared to provide slight advantage survival. In conclusion, frequent evasion alloreactivity malignancies transplanted MMRDs, warranting routine screening this setting.