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Sajulga R, Bolon YT, Maiers MJ, Petersdorf EW. Assessment of HLA-DPB1 genetic variation using an HLA-DP tool and its implications in clinical transplantation. Blood Adv 2023; 7:4809-4821. [PMID: 37126658 PMCID: PMC10469530 DOI: 10.1182/bloodadvances.2022009554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/06/2023] [Accepted: 04/23/2023] [Indexed: 05/03/2023] Open
Abstract
HLA-DP is a classic transplantation antigen that mediates alloreactivity through T-cell epitope (TCE) diversity and expression levels. A current challenge is to integrate these functional features into the prospective selection of unrelated donor candidates for transplantation. Genetically, HLA-DPB1 exon 2 defines the permissive and nonpermissive TCE groups, and exons 2 and 3 (in linkage with rs9277534) indicate low- and high-expression allotypes. In this study, we analyzed 356 272 exon 2-exon 3-phased sequences from individuals across 5 self-identified race and ethnicity categories: White, Hispanic, Asian or Pacific Islander, Black or African American, and American Indian or Alaskan Native. This sequence data set revealed the complex relationship between TCE and expression models and the importance of exon 3 sequence data. We also studied archived donor search lists for 2545 patients who underwent transplantation from an HLA-11/12 unrelated donor mismatched for a single HLA-DPB1 allele. Depending on the order in which the TCE and expression criteria were considered, some patients had different TCE- and expression-favorable donors. In addition, this data set revealed that many expression-favorable alternatives existed in the search lists. To improve the selection of candidate donors, we provide, disseminate, and automate our findings through our multifaceted tool called Expression of HLA-DP Assessment Tool, consisting of a public web application, Python package, and analysis pipeline.
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Affiliation(s)
- Ray Sajulga
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Yung-Tsi Bolon
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Martin J. Maiers
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Effie W. Petersdorf
- Division of Clinical Research, Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
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2
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Pang Y, Holtzman NG. Immunopathogenic mechanisms and modulatory approaches to graft-versus-host disease prevention in acute myeloid leukaemia. Best Pract Res Clin Haematol 2023; 36:101475. [PMID: 37353287 PMCID: PMC10291443 DOI: 10.1016/j.beha.2023.101475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/03/2023] [Accepted: 05/03/2023] [Indexed: 06/25/2023]
Abstract
Allogeneic haematopoietic stem cell transplantation (HSCT) remains the only potential cure for intermediate to high-risk acute myeloid leukaemia (AML). The therapeutic effect of HSCT is largely dependent on the powerful donor-derived immune response against recipient leukaemia cells, known as graft-versus-leukaemia effect (GvL). However, the donor-derived immune system can also cause acute or chronic damage to normal recipient organs and tissues, in a process known as graft-versus-host disease (GvHD). GvHD is a leading cause of non-relapse mortality in HSCT recipients. There are many similarities and cross talk between the immune pathways of GvL and GvHD. Studies have demonstrated that both processes require the presence of mismatched alloantigens between the donor and recipient, and activation of immune responses centered around donor T-cells, which can be further modulated by various recipient or donor factors. Dissecting GvL from GvHD to achieve more effective GvHD prevention and enhanced GvL has been the holy grail of HSCT research. In this review, we focused on the key factors that contribute to the immune responses of GvL and GvHD, the effect on GvL with different GvHD prophylactic strategies, and the potential impact of various AML relapse prevention therapy or treatments on GvHD.
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Affiliation(s)
- Yifan Pang
- Department of Haematologic Oncology and Blood Disorders, Levine Cancer Institute, Charlotte, NC, USA.
| | - Noa G Holtzman
- Immune Deficiency Cellular Therapy Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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3
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Suzuki S, Morishima S, Murata M, Tanaka M, Shigenari A, Ito S, Kanga U, Kulski JK, Morishima Y, Shiina T. Sequence Variations Within HLA-G and HLA-F Genomic Segments at the Human Leukocyte Antigen Telomeric End Associated With Acute Graft-Versus-Host Disease in Unrelated Bone Marrow Transplantation. Front Immunol 2022; 13:938206. [PMID: 35935961 PMCID: PMC9351719 DOI: 10.3389/fimmu.2022.938206] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Acute graft-versus-host disease (aGVHD) is defined as a syndrome of an immunological response of graft to the host that occurs early after allogeneic hematopoietic stem cell transplantation (HCT). This disease is frequently observed even in HCT matched for human leukocyte antigen (HLA) alleles at multiple gene loci. Although the HLA region represents complex and diverse genomic characteristics, detailed association analysis is required for the identification of uncharacterized variants that are strongly associated with aGVHD. We genotyped three loci, OR2H2, HLA-F-AS1, and HLA-G, that are located in the 460 kb of HLA telomeric region and statistically analyzed the genotypes including HLA-DPB1 with clinical and transplantation outcomes using 338 unrelated bone marrow transplantation (UR-BMT) patient–donor pairs who were matched for HLA-A, HLA-B, HLA-C, HLA-DRB1, and HLA-DQB1 (HLA-10/10). Multivariate analyses demonstrated that HLA-F-AS1 and HLA-DPB1 mismatches were associated with grade II–IV aGVHD (hazard ratio (HR), 1.76; 95% CI, 1.07–2.88; p = 0.026; and HR, 1.59; CI, 1.02–2.49; p = 0.042, respectively). There was no confounding between HLA-F-AS1 and HLA-DPB1 (p = 0.512), suggesting that the HLA-F-AS1 mismatch has a strong effect on aGVHD independently of HLA-DPB1. Moreover, a stratified analysis suggested possible associations of HLA-F-AS1, HLA-DPB1, and/or HLA-G mismatches with grade II–IV aGVHD and the more severe grade III–IV aGVHD. These findings provide new insights into understanding the molecular mechanism of aGVHD caused by HLA-matched UR-BMT.
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Affiliation(s)
- Shingo Suzuki
- Department of Molecular Life Science, Tokai University School of Medicine, Isehara, Japan
| | - Satoko Morishima
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology, Second Department of Internal Medicine, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Makoto Murata
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masafumi Tanaka
- Department of Molecular Life Science, Tokai University School of Medicine, Isehara, Japan
| | - Atsuko Shigenari
- Department of Molecular Life Science, Tokai University School of Medicine, Isehara, Japan
| | - Sayaka Ito
- Department of Molecular Life Science, Tokai University School of Medicine, Isehara, Japan
| | - Uma Kanga
- Clinical Immunogenetics Laboratory, Centre for Excellence in Molecular Medicine, Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, New Delhi, India
| | - Jerzy K. Kulski
- Department of Molecular Life Science, Tokai University School of Medicine, Isehara, Japan
- Faculty of Health and Medical Sciences, The University of Western Australia Medical School, Crawley, WA, Australia
| | - Yasuo Morishima
- Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University School of Medicine, Nagakute, Japan
- Department of Hematology and Oncology, Nakagami Hospital, Okinawa, Japan
| | - Takashi Shiina
- Department of Molecular Life Science, Tokai University School of Medicine, Isehara, Japan
- *Correspondence: Takashi Shiina,
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4
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Morishima Y, Morishima S, Stevenson P, Kodera Y, Horowitz M, McKallor C, Malkki M, Spellman SR, Gooley T, Petersdorf EW. Race and Survival in Unrelated Hematopoietic Cell Transplantation. Transplant Cell Ther 2022; 28:357.e1-357.e6. [PMID: 35405366 DOI: 10.1016/j.jtct.2022.03.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/14/2022] [Accepted: 03/30/2022] [Indexed: 11/18/2022]
Abstract
Survival after hematopoietic cell transplantation depends on race/ethnicity and histocompatibility (HLA) between the patient and transplant donor. HLA sequence variation is a genetic construct of continental populations, but its role in accounting for racial disparities of transplant outcome is unknown. To determine disparities in transplant survivorship among patients of diverse race while accounting for patient and donor HLA variation. A total of 26,945 self-described Japanese, U.S. Asian, White, Hispanic, and Black patients received an unrelated donor transplant for the treatment of a life-threatening blood disorder. The risk of mortality with and without adjustment for known HLA risk factors (number and location of donor mismatches; patient HLA-B leader genotype and HLA-DRβ peptide-binding motif) was studied using multivariable models. Survival after HLA-matched transplantation for patients with optimal leader and peptide-binding features was estimated for each race, as was the improvement in survival over calendar-year time by considering year of transplantation as a continuous linear variable. The number, location, and nature of donor HLA mismatches and the frequency of patient HLA-B and HLA-DRB1 sequence motifs differed by race. Japanese patients had superior survival compared to other races without consideration of HLA. After HLA adjustment, three mortality risk strata were identified: Japanese and U.S. Asian (low-risk); White and Hispanic (intermediate-risk), and Black patients (high-risk). Survival for patients with optimal donor and HLA characteristics was superior for Japanese, intermediate for U.S. Asian, White, and Hispanic, and lowest for Black patients. Five-year increments of transplant year were associated with greater decreases in mortality hazards for Black and Hispanic patients than for Japanese, U.S. Asian and White patients. Transplant survivorship disparities are influenced by HLA as a genetic construct of race. A more complete understanding of the factors that influence transplant outcomes provides opportunities to narrow disparities for future patients.
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Affiliation(s)
- Yasuo Morishima
- Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University, Nagakute Japan; Department of Hematology and Oncology, Nakagami Hospital, Okinawa, Japan.
| | - Satoko Morishima
- Division of Endocrinology, Diabetes and Metabolism, Hematology and Rheumatology, Second Department of Internal Medicine, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Phil Stevenson
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Yoshihisa Kodera
- Japan Marrow Donor Program, Tokyo, Japan; Center for Hematopoietic Stem Cell Transplantation, Aichi Medical University Hospital, Nagakute, Japan
| | - Mary Horowitz
- Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Caroline McKallor
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mari Malkki
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Stephen R Spellman
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Ted Gooley
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Effie W Petersdorf
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington.
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5
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Human leukocyte antigen (HLA) haplotype matching in unrelated single HLA allele mismatch bone marrow transplantation. Bone Marrow Transplant 2022; 57:407-415. [DOI: 10.1038/s41409-021-01552-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 11/03/2021] [Accepted: 12/08/2021] [Indexed: 11/08/2022]
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6
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Partanen J, Hyvärinen K, Bickeböller H, Bogunia-Kubik K, Crossland RE, Ivanova M, Perutelli F, Dressel R. Review of Genetic Variation as a Predictive Biomarker for Chronic Graft-Versus-Host-Disease After Allogeneic Stem Cell Transplantation. Front Immunol 2020; 11:575492. [PMID: 33193367 PMCID: PMC7604383 DOI: 10.3389/fimmu.2020.575492] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/28/2020] [Indexed: 12/11/2022] Open
Abstract
Chronic graft-versus-host disease (cGvHD) is one of the major complications of allogeneic stem cell transplantation (HSCT). cGvHD is an autoimmune-like disorder affecting multiple organs and involves a dermatological rash, tissue inflammation and fibrosis. The incidence of cGvHD has been reported to be as high as 30% to 60% and there are currently no reliable tools for predicting the occurrence of cGvHD. There is therefore an important unmet clinical need for predictive biomarkers. The present review summarizes the state of the art for genetic variation as a predictive biomarker for cGvHD. We discuss three different modes of action for genetic variation in transplantation: genetic associations, genetic matching, and pharmacogenetics. The results indicate that currently, there are no genetic polymorphisms or genetic tools that can be reliably used as validated biomarkers for predicting cGvHD. A number of recommendations for future studies can be drawn. The majority of studies to date have been under-powered and included too few patients and genetic markers. Like in all complex multifactorial diseases, large collaborative genome-level studies are now needed to achieve reliable and unbiased results. Some of the candidate genes, in particular, CTLA4, HSPE, IL1R1, CCR6, FGFR1OP, and IL10, and some non-HLA variants in the HLA gene region have been replicated to be associated with cGvHD risk in independent studies. These associations should now be confirmed in large well-characterized cohorts with fine mapping. Some patients develop cGvHD despite very extensive immunosuppression and other treatments, indicating that the current therapeutic regimens may not always be effective enough. Hence, more studies on pharmacogenetics are also required. Moreover, all of these studies should be adjusted for diagnostic and clinical features of cGvHD. We conclude that future studies should focus on modern genome-level tools, such as machine learning, polygenic risk scores and genome-wide association study-transcription meta-analyses, instead of focusing on just single variants. The risk of cGvHD may be related to the summary level of immunogenetic differences, or whole genome histocompatibility between each donor-recipient pair. As the number of genome-wide analyses in HSCT is increasing, we are approaching an era where there will be sufficient data to incorporate these approaches in the near future.
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Affiliation(s)
- Jukka Partanen
- Finnish Red Cross Blood Service, Research and Development, Helsinki, Finland
| | - Kati Hyvärinen
- Finnish Red Cross Blood Service, Research and Development, Helsinki, Finland
| | - Heike Bickeböller
- Department of Genetic Epidemiology, University Medical Center Göttingen, Göttingen, Germany
| | - Katarzyna Bogunia-Kubik
- Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - Rachel E Crossland
- Haematological Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Milena Ivanova
- Medical University, University Hospital Alexandrovska, Sofia, Bulgaria
| | - Francesca Perutelli
- Haematological Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.,Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ralf Dressel
- Institute of Cellular and Molecular Immunology, University Medical Center Göttingen, Göttingen, Germany
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7
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Getz J, Goldenstein M, Bonfim C, Funke VM, Colturato V, Hamerschlak N, Torres M, Sayer D, Boldt A, Pasquini R, Pereira NF. Investigation of MHC gamma block C4A and C4B polymorphisms in unrelated hematopoietic stem cell transplantation. Hematol Transfus Cell Ther 2019; 42:221-229. [PMID: 31801701 PMCID: PMC7417459 DOI: 10.1016/j.htct.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 06/21/2019] [Accepted: 06/29/2019] [Indexed: 12/21/2022] Open
Abstract
Background Immunological life-threatening complications frequently occur in post-hematopoietic stem cell transplantation (HSCT), despite matching recipient and donor (R/D) pairs for classical human leukocyte antigens (HLA). Studies have shown that R/D non-HLA disparities within the major histocompatibility complex (MHC) are associated with adverse effects post-HSCT. Methods We investigated the impact of mismatches of single-nucleotide polymorphisms (SNPs) in C4A/C4B genes, for showing the highest diversity in the MHC gamma block, on 238 patients who underwent HLA 10/10 unrelated donor (URD) HSCT. The endpoints were acute graft-versus-host disease (aGVHD), chronic graft-versus-host disease (cGVHD) and mortality. One hundred and twenty-nine R/D pairs had 23 C4-SNPs typed by PCR-SSP (Gamma-Type™v.1.0), and 109 R/D pairs had these 23 SNPs identified by next-generation sequencing (NGS) using the Illumina platform. Results The percentage of patients who received HSC from HLA 10/10 donors with 1–7 mismatches was 42.9%. The R/D pairs were considered C4 mismatched when bearing at least one disparity. These mismatches were not found to be risk factors for aGVHD, cGVHD or mortality after unrelated HSCT when SNPs were analyzed together (matched or mm ≥ 1), independently or according to the percentage of incompatibilities (full match for 23 SNPs; 1–3 mm and >3 mm). An exception was the association between 1–3 mismatches at the composite of SNPs C13193/T14952/T19588 with the development of aGVHD (P = 0.012) and with grades III-IV of this disease (P = 0.004). Conclusion Our data are not consistent with the hypothesis that disparities in C4A/C4B SNPs increase the risks of post-HSCT adverse effects for the endpoints investigated in this study.
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Affiliation(s)
- Joselito Getz
- Hospital de Clínicas - Universidade Federal do Paraná (HC-UFPR), Curitiba, PR, Brazil.
| | - Monica Goldenstein
- Hospital de Clínicas - Universidade Federal do Paraná (HC-UFPR), Curitiba, PR, Brazil
| | - Carmem Bonfim
- Hospital de Clínicas - Universidade Federal do Paraná (HC-UFPR), Curitiba, PR, Brazil
| | - Vaneuza Moreira Funke
- Hospital de Clínicas - Universidade Federal do Paraná (HC-UFPR), Curitiba, PR, Brazil
| | | | | | - Margareth Torres
- Hospital Amaral Carvalho, Jaú, SP, Brazil; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - Angelica Boldt
- Hospital de Clínicas - Universidade Federal do Paraná (HC-UFPR), Curitiba, PR, Brazil; Genetics Department - Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Ricardo Pasquini
- Hospital de Clínicas - Universidade Federal do Paraná (HC-UFPR), Curitiba, PR, Brazil; Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
| | - Noemi Farah Pereira
- Hospital de Clínicas - Universidade Federal do Paraná (HC-UFPR), Curitiba, PR, Brazil
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8
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Motaei J, Yaghmaie M, Ahmadvand M, Pashaiefar H, Kerachian MA. MicroRNAs as Potential Diagnostic, Prognostic, and Predictive Biomarkers for Acute Graft-versus-Host Disease. Biol Blood Marrow Transplant 2019; 25:e375-e386. [PMID: 31419566 DOI: 10.1016/j.bbmt.2019.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 02/06/2023]
Abstract
Successful treatment of various hematologic diseases with allogeneic hematopoietic stem cell transplantation is often limited due to the occurrence of acute graft-versus-host disease (aGVHD). So far, there are no approved molecular biomarkers for the diagnosis and prediction of aGVHD at the clinical level due to our incomplete understanding of the molecular biology of the disease. Various studies have been conducted on animal models and humans to investigate the role of microRNAs in aGVHD pathogenesis to implicate them as biomarkers and therapeutic targets. Because of their high stability, tissue specificity, ease of measurement, low cost, and simplicity, they are excellent targets for biomarkers. In this review, we focused on microRNA expression profiling studies that were performed recently in both animal models and human cases of aGVHD to identify diagnostic and predictive biomarkers for this disease. The expression pattern of microRNAs can be specific to cells and tissues. Because aGVHD affects several organs, microRNA signatures in target tissues may help to understand the molecular pathology of the disease. Identification of organ-specific microRNAs in aGVHD can be promising to categorize patients for organ-specific therapies. Thus, microRNAs can be used as noninvasive diagnostic tests in clinic to improve prophylaxis, predict incidence and severity, and reduce morbidity.
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Affiliation(s)
- Jamshid Motaei
- Medical Genetics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Medical Genetics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Marjan Yaghmaie
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ahmadvand
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Pashaiefar
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Amin Kerachian
- Medical Genetics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Medical Genetics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Cancer Genetics Research Unit, Reza Radiotherapy and Oncology Center, Mashhad, Iran.
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9
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Mayor NP, Hayhurst JD, Turner TR, Szydlo RM, Shaw BE, Bultitude WP, Sayno JR, Tavarozzi F, Latham K, Anthias C, Robinson J, Braund H, Danby R, Perry J, Wilson MC, Bloor AJ, McQuaker IG, MacKinnon S, Marks DI, Pagliuca A, Potter MN, Potter VT, Russell NH, Thomson KJ, Madrigal JA, Marsh SG. Recipients Receiving Better HLA-Matched Hematopoietic Cell Transplantation Grafts, Uncovered by a Novel HLA Typing Method, Have Superior Survival: A Retrospective Study. Biol Blood Marrow Transplant 2019; 25:443-450. [DOI: 10.1016/j.bbmt.2018.12.768] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/22/2018] [Indexed: 10/27/2022]
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10
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Petersdorf EW, O'hUigin C. The MHC in the era of next-generation sequencing: Implications for bridging structure with function. Hum Immunol 2019; 80:67-78. [PMID: 30321633 PMCID: PMC6542361 DOI: 10.1016/j.humimm.2018.10.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 09/24/2018] [Accepted: 10/01/2018] [Indexed: 12/19/2022]
Abstract
The MHC continues to have the most disease-associations compared to other regions of the human genome, even in the genome-wide association study (GWAS) and single nucleotide polymorphism (SNP) era. Analysis of non-coding variation and their impact on the level of expression of HLA allotypes has shed new light on the potential mechanisms underlying HLA disease associations and alloreactivity in transplantation. Next-generation sequencing (NGS) technology has the capability of delineating the phase of variants in the HLA antigen-recognition site (ARS) with non-coding regulatory polymorphisms. These relationships are critical for understanding the qualitative and quantitative implications of HLA gene diversity. This article summarizes current understanding of non-coding region variation of HLA loci, the consequences of regulatory variation on HLA expression, the role for evolution in shaping lineage-specific expression, and the impact of HLA expression on disease susceptibility and transplantation outcomes. A role for phased sequencing methods for the MHC, and perspectives for future directions in basic and applied immunogenetic studies of the MHC are presented.
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Affiliation(s)
- Effie W Petersdorf
- University of Washington, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, D4-115, Seattle, WA 98109, United States.
| | - Colm O'hUigin
- Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Microbiome and Genetics Core, Building 37, Room 4140B, Bethesda, MD 20852, United States.
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11
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Wais V, Bunjes D, Kuchenbauer F, Sorror ML. Comorbidities, age, and other patient-related predictors of allogeneic hematopoietic cell transplantation outcomes. Expert Rev Hematol 2018; 11:805-816. [PMID: 30092693 DOI: 10.1080/17474086.2018.1509703] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Allogeneic hematopoietic cell transplantation (HCT) provides potential cure to a large number of malignant and nonmalignant hematological disorders. With the development of non-myeloablative and reduced-intensity conditioning regimens, allogeneic HCT can nowadays be offered to a number of older or medically unfit patients. Up until the twenty-first century, chronological age was considered a hypothetical barrier. Recent reports, however, have shown that comorbidities, function, and other patient-related factors influence HCT outcomes at a higher magnitude than age alone. Areas covered: To define the eligibility of older or medically unfit patients for allogeneic HCT, a range of factors have to be considered. To solve this considerable issue, we need to further understand the mechanism and consequences of aging, such as chronic inflammation, sarcopenia, and especially the structure of frailty. Domains covering functional, physical, mental, social, nutritional, bone, and other health statuses should be evaluated and considered. Expert commentary: In this review we merge the current assessment tools with the potential approaches to objectify functional resources, as well as with possible methods to improve these resources in older or otherwise medically unfit patients prior to allogeneic HCT.
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Affiliation(s)
- Verena Wais
- a Clinical Research Division , Fred Hutchinson Cancer Research Center , Seattle , WA , USA.,b Department of Internal Medicine III , University Hospital of Ulm , Ulm , Germany
| | - Donald Bunjes
- b Department of Internal Medicine III , University Hospital of Ulm , Ulm , Germany
| | - Florian Kuchenbauer
- b Department of Internal Medicine III , University Hospital of Ulm , Ulm , Germany
| | - Mohamed L Sorror
- a Clinical Research Division , Fred Hutchinson Cancer Research Center , Seattle , WA , USA.,c Division of Medical Oncology, Department of Medicine , University of Washington School of Medicine , Seattle , WA , USA
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12
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Petersdorf EW. In celebration of Ruggero Ceppellini: HLA in transplantation. HLA 2018; 89:71-76. [PMID: 28102037 DOI: 10.1111/tan.12955] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 12/17/2022]
Abstract
The availability of hematopoietic cell transplantation as curative therapy for blood disorders has been dramatically improved through a better understanding of the human leukocyte antigen (HLA) barrier. Although a fully compatible unrelated donor is preferable, transplantation from donors with a limited degree of HLA mismatching is associated with acceptable outcomes in many cases. Research on the limits of HLA mismatching, and the features that define permissible HLA mismatches will continue to enable transplantation to be more broadly available to patients in need.
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Affiliation(s)
- E W Petersdorf
- Fred Hutchinson Cancer Research Center, Division of Clinical Research, Seattle, Washington
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13
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Misra MK, Damotte V, Hollenbach JA. The immunogenetics of neurological disease. Immunology 2018; 153:399-414. [PMID: 29159928 PMCID: PMC5838423 DOI: 10.1111/imm.12869] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/09/2017] [Accepted: 11/14/2017] [Indexed: 12/18/2022] Open
Abstract
Genes encoding antigen-presenting molecules within the human major histocompatibility complex (MHC) account for the highest component of genetic risk for many neurological diseases, such as multiple sclerosis, neuromyelitis optica, Parkinson's disease, Alzheimer's disease, schizophrenia, myasthenia gravis and amyotrophic lateral sclerosis. Myriad genetic, immunological and environmental factors may contribute to an individual's susceptibility to neurological disease. Here, we review and discuss the decades long research on the influence of genetic variation at the MHC locus and the role of immunogenetic killer cell immunoglobulin-like receptor (KIR) loci in neurological diseases, including multiple sclerosis, neuromyelitis optica, Parkinson's disease, Alzheimer's disease, schizophrenia, myasthenia gravis and amyotrophic lateral sclerosis. The findings of immunogenetic association studies are consistent with a polygenic model of inheritance in the heterogeneous and multifactorial nature of complex traits in various neurological diseases. Future investigation is highly recommended to evaluate both coding and non-coding variation in immunogenetic loci using high-throughput high-resolution next-generation sequencing technologies in diverse ethnic groups to fully appreciate their role in neurological diseases.
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Affiliation(s)
- Maneesh K. Misra
- Department of NeurologySan Francisco School of MedicineUniversity of CaliforniaSan FranciscoCAUSA
| | - Vincent Damotte
- Department of NeurologySan Francisco School of MedicineUniversity of CaliforniaSan FranciscoCAUSA
| | - Jill A. Hollenbach
- Department of NeurologySan Francisco School of MedicineUniversity of CaliforniaSan FranciscoCAUSA
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Hidden genomic MHC disparity between HLA-matched sibling pairs in hematopoietic stem cell transplantation. Sci Rep 2018; 8:5396. [PMID: 29599509 PMCID: PMC5876349 DOI: 10.1038/s41598-018-23682-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 03/16/2018] [Indexed: 12/30/2022] Open
Abstract
Matching classical HLA alleles between donor and recipient is an important factor in avoiding adverse immunological effects in HSCT. Siblings with no differences in HLA alleles, either due to identical-by-state or identical-by-descent status, are considered to be optimal donors. We carried out a retrospective genomic sequence and SNP analysis of 336 fully HLA-A, -B, -DRB1 matched and 14 partially HLA-matched sibling HSCT pairs to determine the level of undetected mismatching within the MHC segment as well as to map their recombination sites. The genomic sequence of 34 genes locating in the MHC region revealed allelic mismatching at 1 to 8 additional genes in partially HLA-matched pairs. Also, fully matched pairs were found to have mismatching either at HLA-DPB1 or at non-HLA region within the MHC segment. Altogether, 3.9% of fully HLA-matched HSCT pairs had large genomic mismatching in the MHC segment. Recombination sites mapped to certain restricted locations. The number of mismatched nucleotides correlated with the risk of GvHD supporting the central role of full HLA matching in HSCT. High-density genome analysis revealed that fully HLA-matched siblings may not have identical MHC segments and even single allelic mismatching at any classical HLA gene often implies larger genomic differences along MHC.
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15
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Petersdorf EW, Anasetti C. Unrelated Donor Hematopoietic Cell Transplantation. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00105-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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16
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HLA-DP in unrelated hematopoietic cell transplantation revisited: challenges and opportunities. Blood 2017; 130:1089-1096. [PMID: 28667011 DOI: 10.1182/blood-2017-03-742346] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 06/17/2017] [Indexed: 11/20/2022] Open
Abstract
When considering HLA-matched hematopoietic cell transplantation (HCT), sibling and unrelated donors (UDs) are biologically different because UD-HCT is typically performed across HLA-DP disparities absent in sibling HCT. Mismatched HLA-DP is targeted by direct alloreactive T cell responses with important implications for graft-versus-host disease and graft-versus-leukemia. This concise review details special features of HLA-DP as model antigens for clinically permissive mismatches mediating limited T-cell alloreactivity with minimal toxicity, and describes future avenues for their exploitation in cellular immunotherapy of malignant blood disorders.
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17
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Petersdorf EW. Role of major histocompatibility complex variation in graft-versus-host disease after hematopoietic cell transplantation. F1000Res 2017; 6:617. [PMID: 28529723 PMCID: PMC5419254 DOI: 10.12688/f1000research.10990.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2017] [Indexed: 01/01/2023] Open
Abstract
Graft-versus-host disease (GVHD) remains a significant potentially life-threatening complication of allogeneic hematopoietic cell transplantation (HCT). Since the discovery of the human leukocyte antigen (HLA) system over 50 years ago, significant advances have clarified the nature of HLA variation between transplant recipients and donors as a chief etiology of GVHD. New information on coding and non-coding gene variation and GVHD risk provides clinicians with options to consider selected mismatched donors when matched donors are not available. These advances have increased the availability of unrelated donors for patients in need of a transplant and have lowered the overall morbidity and mortality of HCT.
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18
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Bahram S, Carapito R, Gourraud PA, Charron D. The TRANSPLANTEX initiative. Hum Immunol 2016; 77:1005-1007. [PMID: 27881245 DOI: 10.1016/j.humimm.2016.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
TRANSPLANTEX, a French "investment for the future" initiated consortium of leading transplant units and research laboratories across France and a number of European countries aims to unravel, through mainly high-throughput genomics (and other omics) analyses of donor and recipients, novel (a) non-HLA, histocompatibility antigens, whether inside, or outside the MHC; (b) pre/post transplantation biomarkers. This shall lead to our better understanding of the pathophysiology of (and eventually designing better therapeutics for) the graft-versus-host disease in hematopoietic cell transplants and that of chronic graft rejection after kidney transplant. Industrial developments as well as innovative teaching initiatives are also integral part of this program. The present issue of Human Immunology aims to present a first snapshot of some of the research performed by TRANPLANTEX partners.
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Affiliation(s)
- Seiamak Bahram
- LabEx TRANSPLANTEX; Laboratoire d'ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, Centre de Recherche d'Immunologie et d'Hématologie, Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, 67085 Strasbourg Cedex, France; INSERM Franco-Japanese Nextgen HLA Laboratory (FJ-HLA), Laboratoire International Associé (LIA), 67000 Strasbourg, France; Fédération Hospitalo-Universitaire, OMICARE, Centre de Recherche d'Immunologie et d'Hématologie, 67085 Strasbourg Cedex, France; Laboratoire d'Immunologie, Plateau Technique de Biologie, Pôle de Biologie, Nouvel Hôpital Civil, 67091 Strasbourg Cedex, France.
| | - Raphael Carapito
- LabEx TRANSPLANTEX; Laboratoire d'ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, Centre de Recherche d'Immunologie et d'Hématologie, Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, 67085 Strasbourg Cedex, France; INSERM Franco-Japanese Nextgen HLA Laboratory (FJ-HLA), Laboratoire International Associé (LIA), 67000 Strasbourg, France; Fédération Hospitalo-Universitaire, OMICARE, Centre de Recherche d'Immunologie et d'Hématologie, 67085 Strasbourg Cedex, France; Laboratoire d'Immunologie, Plateau Technique de Biologie, Pôle de Biologie, Nouvel Hôpital Civil, 67091 Strasbourg Cedex, France
| | - Pierre-Antoine Gourraud
- LabEx TRANSPLANTEX, CHU de Nantes, ATIP-Avenir Team, ITUN-CRTI-UMR Inserm 1064 - Hospital and University of Nantes, 44000, France; Department of Neurology, University of California, San Francisco, CA 94117, USA
| | - Dominique Charron
- LabEx TRANSPLANTEX; HLA & Médecine "Jean Dausset" Laboratory Network, Hôpital Saint-Louis AP-HP, Université Paris Diderot, 75013, France; JiaoTong University, Rujin Hospital Shanghai, China
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19
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Goyal RK, Lee SJ, Wang T, Trucco M, Haagenson M, Spellman SR, Verneris M, Ferrell RE. Novel HLA-DP region susceptibility loci associated with severe acute GvHD. Bone Marrow Transplant 2016; 52:95-100. [PMID: 27595289 DOI: 10.1038/bmt.2016.210] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 06/02/2016] [Accepted: 06/17/2016] [Indexed: 12/17/2022]
Abstract
Despite HLA allele matching, significant acute GvHD remains a major barrier to successful unrelated donor BMT. We conducted a genome-wide association study (GWAS) to identify recipient and donor genes associated with the risk of acute GvHD. A case-control design (grade III-IV versus no acute GvHD) and pooled GWA approach was used to study European-American recipients with hematological malignancies who received myeloablative conditioning non-T-cell-depleted first transplantation from HLA-A, -B, -C, -DRB1, -DQB1 allele level (10/10) matched unrelated donors. DNA samples were divided into three pools and tested in triplicate using the Affymetrix Genome-wide SNP Array 6.0. We identified three novel susceptibility loci in the HLA-DP region of recipient genomes that were associated with III-IV acute GvHD (rs9277378, P=1.58E-09; rs9277542, P=1.548E-06 and rs9277341, P=7.718E-05). Of these three single nucleotide polymorphisms (SNPs), rs9277378 and rs9277542 are located in non-coding regions of the HLA-DPB1 gene and the two are in strong linkage disequilibrium with two other published SNPs associated with acute GvHD, rs2281389 and rs9277535. Eighteen other recipient SNPs and 3 donor SNPs with a high level of significance (8E-07 or lower) were found. Our report contributes to emerging data showing clinical significance of the HLA-DP region genetic markers beyond structural matching of DPB1 alleles.
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Affiliation(s)
- R K Goyal
- Department of Pediatric of Blood and Marrow Transplantation and Cellular Therapies, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Division of Hematology, Oncology and Blood and Marrow Transplantation, Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA
| | - S J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Biostatistics, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - T Wang
- Department of Biostatistics, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - M Trucco
- Division of Immunogenetics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, PA, USA
| | - M Haagenson
- Department of Immunobiology and Observational Research, Center for International Blood and Marrow Transplant Research, Minneapolis, MN, USA
| | - S R Spellman
- Department of Immunobiology and Observational Research, Center for International Blood and Marrow Transplant Research, Minneapolis, MN, USA
| | - M Verneris
- Department of Pediatric BMT, University of Minnesota, Minneapolis, MN, USA
| | - R E Ferrell
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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20
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Elsawy M, Sorror ML. Up-to-date tools for risk assessment before allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2016; 51:1283-1300. [PMID: 27272454 DOI: 10.1038/bmt.2016.141] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 03/13/2016] [Accepted: 04/11/2016] [Indexed: 12/13/2022]
Abstract
Cure of malignant and non-malignant hematological diseases is potentially possible after allogeneic hematopoietic stem cell transplantation (HCT). Accurate evaluation of the risk-benefit ratio for an individual patient could improve the decision-making process about transplant, which ultimately would increase the likelihood of success. Several transplant-related models were designed in an effort to optimize decision-making about suitable candidates for allogeneic HCT. In 1998, The European Society for Blood and Marrow Transplantation (EBMT) developed a five-component pretransplantation risk scoring system for patients with CML. The EBMT score was later tested in patients with various hematological disorders, and it was shown to stratify risks of mortality after allogeneic HCT. More recent research efforts focused on models that assess health status before HCT. A HCT-specific comorbidity index was designed to assign weights to 17 relevant comorbidities that were shown to independently predict non-relapse mortality. Performance status scales and comprehensive geriatric assessment tools might uncover additional overall health limitations that affect long-term survival among older recipients of allogeneic HCT. Other models include the pretransplantation assessment of mortality score that summarizes the impacts of eight different pretransplantation patient- and disease-specific variables into a 50-point model that predicts survival. The disease-risk index captures the impact of primary diagnoses and disease status on relapse and survival following allogeneic HCT. The values and limitations of each model are discussed herein. We also provide insight on how to use these models in the clinic to decide about offering allogeneic HCT with the most suitable conditioning regimen intensity.
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Affiliation(s)
- M Elsawy
- Transplantation Biology Program, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - M L Sorror
- Transplantation Biology Program, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
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21
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Tiercy JM. How to select the best available related or unrelated donor of hematopoietic stem cells? Haematologica 2016; 101:680-7. [PMID: 27252513 DOI: 10.3324/haematol.2015.141119] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 03/09/2016] [Indexed: 11/09/2022] Open
Abstract
Recognition of HLA incompatibilities by the immune system represents a major barrier to allogeneic hematopoietic stem cell transplantation. HLA genotypically identical sibling donors are, therefore, the gold standard for transplantation purposes, but only 30% patients have such a donor. For the remaining 70% patients alternative sources of stem cells are a matched unrelated adult volunteer donor, a haploidentical donor or a cord blood unit. The definition of 'HLA matching' depends on the level of resolution and on which loci are tested. The development of HLA molecular typing technologies and the availability of more than 27 million donors in the international database has greatly facilitated unrelated donor searches. The gold standard is high resolution typing at the HLA-A, -B, -C, -DRB1, and -DQB1 loci (10/10 match). Single disparities for HLA-A, -B, - C, or -DRB1 are associated with increased risk of post-transplant complications, but less so in patients with advanced disease, and in those undergoing T-cell-depleted allografting. HLA-DQB1 mismatches seem to be better tolerated and some HLA-C, -DRB1 and -DPB1 disparities are potentially less immunogenic. HLA typing by next-generation sequencing methods is likely to change matching algorithms by providing full sequence information on all HLA loci in a single step. In most European populations a 10/10 matched donor can be found for at least 50% of patients and an additional 20-30% patients may have a 9/10 matched donor. Genetic factors that help in identifying donors with less immunogenic mismatches are discussed. Haploidentical donors are increasingly used as an alternative source of stem cells for those patients lacking a matched unrelated donor.
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Affiliation(s)
- Jean-Marie Tiercy
- National Reference Laboratory for Histocompatibility, Department of Genetic and Laboratory Medicine, University Hospitals Geneva, Switzerland
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22
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Sasazuki T, Inoko H, Morishima S, Morishima Y. Gene Map of the HLA Region, Graves’ Disease and Hashimoto Thyroiditis, and Hematopoietic Stem Cell Transplantation. Adv Immunol 2016; 129:175-249. [DOI: 10.1016/bs.ai.2015.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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23
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Intrahaplotypic Variants Differentiate Complex Linkage Disequilibrium within Human MHC Haplotypes. Sci Rep 2015; 5:16972. [PMID: 26593880 PMCID: PMC4655331 DOI: 10.1038/srep16972] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 10/22/2015] [Indexed: 12/21/2022] Open
Abstract
Distinct regions of long-range genetic fixation in the human MHC region, known as conserved extended haplotypes (CEHs), possess unique genomic characteristics and are strongly associated with numerous diseases. While CEHs appear to be homogeneous by SNP analysis, the nature of fine variations within their genomic structure is unknown. Using multiple, MHC-homozygous cell lines, we demonstrate extensive sequence conservation in two common Asian MHC haplotypes: A33-B58-DR3 and A2-B46-DR9. However, characterization of phase-resolved MHC haplotypes revealed unique intra-CEH patterns of variation and uncovered 127 single nucleotide variants (SNVs) which are missing from public databases. We further show that the strong linkage disequilibrium structure within the human MHC that typically confounds precise identification of genetic features can be resolved using intra-CEH variants, as evidenced by rs3129063 and rs448489, which affect expression of ZFP57, a gene important in methylation and epigenetic regulation. This study demonstrates an improved strategy that can be used towards genetic dissection of diseases.
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24
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Park Y, Cheong JW, Park MH, Kim MS, Kim JS, Kim HS. Effect of major histocompatibility complex haplotype matching by C4 and MICA genotyping on acute graft versus host disease in unrelated hematopoietic stem cell transplantation. Hum Immunol 2015; 77:176-83. [PMID: 26602146 DOI: 10.1016/j.humimm.2015.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/05/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
Abstract
We explored whether matching of human leukocyte antigen (HLA) haplotypes between the recipient and donor of hematopoietic stem cell transplantation (HSCT) predicted by C4 and MICA typing is associated with the incidence of acute graft versus host disease (aGVHD). DNA preparations collected from a total of 81 recipient and donor pairs were used for PCR-based C4 subtyping and/or MICA sequence-based typing. Incidences of aGVHD were compared according to C4 and MICA matching. The six most common MICA alleles were MICA*008:01, *010:01, *002:01, *004, *009:01/049, and *012:01. Among the 59 unrelated pairs, HLA alleles were matched in 34 (57.6%). C4 subtypes were identical between the recipient and donor in 28 (82.4%) HLA-matched unrelated pairs, while MICA genotypes were matched in all HLA-matched unrelated pairs. In the 22 HLA-matched related pairs, all recipients showed identical C4 subtypes with their respective donors. In multivariate analysis, C4 mismatch was a significant risk factor associated with the development of aGVHD in unrelated HSCT (hazard ratio=3.24, P=0.006). PCR-based C4 subtyping is a simple method for assessing the genetic identity of the HLA region between a recipient and unrelated donor. This test would be also useful for prediction of aGVHD in HSCT.
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Affiliation(s)
- Yongjung Park
- Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - June-Won Cheong
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Myoung Hee Park
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Korea Organ Donation Agency Laboratory, Seoul, Republic of Korea
| | - Myoung Soo Kim
- Division of Transplantation Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Sun Kim
- Department of Microbiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyon-Suk Kim
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Arima N, Nakamura F, Yabe T, Tanaka J, Fuji S, Ohashi K, Fukuda T, Miyamura K, Iwato K, Eto T, Mori T, Kobayashi N, Hoshino T, Kato C, Kanamori H, Nakamae H, Atsuta Y, Morishima Y, Kanda Y. Influence of Differently Licensed KIR2DL1-Positive Natural Killer Cells in Transplant Recipients with Acute Leukemia: A Japanese National Registry Study. Biol Blood Marrow Transplant 2015; 22:423-31. [PMID: 26456260 DOI: 10.1016/j.bbmt.2015.09.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022]
Abstract
Licensing by self MHC class I ligands is required for proper natural killer (NK) cell response. NK cells with inhibitory killer cell immunoglobulin-like receptors for nonself MHC exhibit transient alloreactivity after hematopoietic stem cell transplantation (HSCT). We analyzed 3866 recipients in the Japan national registry who underwent their first allogeneic HSCT for acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL) from HLA-A, -B, and -DRB1 allele-genomatched unrelated donors. By classifying them into 5 independent groups based on HLA-C group matching and assumed donor NK cell status, we found that for HLA-C-matched HSCT for AML in HLA-C1/C1 recipients, in whom transient alloreactivity against HLA-C2-negative leukemic cells was expected, the relapse rate was significantly lower than it was in HLA-C-matched HSCT for AML in HLA-C1/C2 recipients (hazard ratio [HR], .72; P = .011). This difference was not observed in HLA-C-matched HSCT for ALL. Compared with HLA-C-matched HSCT, significantly higher mortality was observed in HLA-C1/C1 AML patients who received transplants from HLA-C-mismatched HLA-C1/C1 donors (HR, 1.37; P = .001) and in HLA-C1/C1 ALL patients who received transplants from HLA-C2-positive donors (HR, 2.13; P = .005). In conclusion, donor selection based on leukemic subtype and donor HLA-C group matching improves transplantation outcome after HLA-C-mismatched HSCT.
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Affiliation(s)
- Nobuyoshi Arima
- Department of Hematology, Medical Research Institute Kitano Hospital, Osaka, Japan.
| | - Fumiaki Nakamura
- Department of Public Health/Health Policy, The University of Tokyo, Tokyo, Japan
| | - Toshio Yabe
- Hematology Division, Japanese Red Cross Tokyo Metropolitan Blood Center, Tokyo, Japan
| | - Junji Tanaka
- Department of Hematology, Tokyo Women's Medical University, Tokyo, Japan
| | - Shigeo Fuji
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuteru Ohashi
- Hematology Division, Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Takahiro Fukuda
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Koichi Miyamura
- Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Koji Iwato
- Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Tetsuya Eto
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Takehiko Mori
- Department of Hematology, Keio University School of Medicine, Tokyo, Japan
| | - Naoki Kobayashi
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Takumi Hoshino
- Leukemia Research Center, Saiseikai Maebashi Hospital, Maebashi, Japan
| | - Chiaki Kato
- Department of Hematology, Meitetsu hospital, Nagoya, Japan
| | - Heiwa Kanamori
- Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan
| | - Hirohisa Nakamae
- Department of Hematology, Osaka City University Hospital, Osaka, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation/Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuo Morishima
- Department of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
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26
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Affiliation(s)
- Katharina Fleischhauer
- From the Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, and the German Cancer Consortium (DKTK), Heidelberg - both in Germany
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27
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Petersdorf EW, Malkki M, O'hUigin C, Carrington M, Gooley T, Haagenson MD, Horowitz MM, Spellman SR, Wang T, Stevenson P. High HLA-DP Expression and Graft-versus-Host Disease. N Engl J Med 2015; 373:599-609. [PMID: 26267621 PMCID: PMC4560117 DOI: 10.1056/nejmoa1500140] [Citation(s) in RCA: 207] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Transplantation of hematopoietic cells from unrelated donors can cure blood disorders but carries a significant risk of acute graft-versus-host disease (GVHD). The risk is higher when the recipient and donor are HLA-DPB1-mismatched, but the mechanisms leading to GVHD are unknown. The HLA-DPB1 regulatory region variant rs9277534 is associated with HLA-DPB1 expression. We tested the hypothesis that the GVHD risk correlates with the rs9277534 allele linked to the mismatched HLA-DPB1 in the recipient. METHODS We genotyped rs9277534 in 3505 persons to define rs9277534-DPB1 haplotypes. Among 1441 recipients of transplants from HLA-A,B,C,DRB1,DQB1-matched unrelated donors with only one HLA-DPB1 mismatch, linkage of the rs9277534 A and G alleles to the mismatched HLA-DPB1 was determined. HLA-DPB1 expression was assessed by means of a quantitative polymerase-chain-reaction assay. The risk of acute GVHD among recipients whose mismatched HLA-DPB1 allele was linked to rs9277534G (high expression) was compared with the risk among recipients whose mismatched HLA-DPB1 allele was linked to rs9277534A (low expression). RESULTS The mean HLA-DPB1 expression was lower with rs9277534A than with rs9277534G. Among recipients of transplants from donors with rs9277534A-linked HLA-DPB1, the risk of acute GVHD was higher for recipients with rs9277534G-linked HLA-DPB1 mismatches than for recipients with rs9277534A-linked HLA-DPB1 mismatches (hazard ratio, 1.54; 95% confidence interval [CI], 1.25 to 1.89; P<0.001), as was the risk of death due to causes other than disease recurrence (hazard ratio, 1.25; 95% CI, 1.00 to 1.57; P=0.05). CONCLUSIONS The risk of GVHD associated with HLA-DPB1 mismatching was influenced by the HLA-DPB1 rs9277534 expression marker. Among recipients of HLA-DPB1-mismatched transplants from donors with the low-expression allele, recipients with the high-expression allele had a high risk of GVHD. (Funded by the National Institutes of Health and others.).
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Affiliation(s)
- Effie W Petersdorf
- From the Division of Clinical Research, Fred Hutchinson Cancer Research Center (E.W.P., M.M., T.G., P.S.), and the Department of Medicine, University of Washington School of Medicine (E.W.P.) - both in Seattle; Cancer and Inflammation Program, Laboratory of Experimental Immunology, Leidos Biomedical Research, Frederick National Laboratories for Cancer Research, Frederick, MD (C.O., M.C.); Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Harvard University, Boston (M.C.); Center for International Blood and Marrow Transplant Research, Minneapolis (M.D.H., S.R.S.); and Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee (M.M.H., T.W.)
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Role of Pharmacogenetics in Hematopoietic Stem Cell Transplantation Outcome in Children. Int J Mol Sci 2015; 16:18601-27. [PMID: 26266406 PMCID: PMC4581262 DOI: 10.3390/ijms160818601] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 06/21/2015] [Accepted: 07/28/2015] [Indexed: 12/18/2022] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is an established therapeutic procedure for several congenital and acquired disorders, both malignant and nonmalignant. Despite the great improvements in HSCT clinical practices over the last few decades, complications, such as graft vs. host disease (GVHD) and sinusoidal obstructive syndrome (SOS), are still largely unpredictable and remain the major causes of morbidity and mortality. Both donor and patient genetic background might influence the success of bone marrow transplantation and could at least partially explain the inter-individual variability in HSCT outcome. This review summarizes some of the recent studies on candidate gene polymorphisms in HSCT, with particular reference to pediatric cohorts. The interest is especially focused on pharmacogenetic variants affecting myeloablative and immunosuppressive drugs, although genetic traits involved in SOS susceptibility and transplant-related mortality are also reviewed.
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Vyas P, Appelbaum FR, Craddock C. Reprint of: Allogeneic Hematopoietic Cell Transplantation for Acute Myeloid Leukemia. Biol Blood Marrow Transplant 2015; 21:S3-10. [DOI: 10.1016/j.bbmt.2014.12.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 10/29/2014] [Indexed: 11/26/2022]
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Vyas P, Appelbaum FR, Craddock C. Allogeneic Hematopoietic Cell Transplantation for Acute Myeloid Leukemia. Biol Blood Marrow Transplant 2015; 21:8-15. [DOI: 10.1016/j.bbmt.2014.10.026] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 10/29/2014] [Indexed: 12/27/2022]
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Biological significance of HLA locus matching in unrelated donor bone marrow transplantation. Blood 2014; 125:1189-97. [PMID: 25519752 DOI: 10.1182/blood-2014-10-604785] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
We hypothesized that the compatibility of each HLA loci between donor and patient induced divergent transplant-related immunologic responses, which attributed to the individualized manifestation of clinical outcomes. Here, we analyzed 7898 Japanese pairs transplanted with T-cell-replete marrow from an unrelated donor with complete HLA allele typing data. Multivariable competing risk regression analyses were conducted to evaluate the relative risk (RR) of clinical outcomes after transplantation. A significant RR of HLA allele mismatch compared with match was seen with HLA-A, -B, -C, and -DPB1 for grade III-IV acute graft-versus-host disease (GVHD), and HLA-C for chronic GVHD. Of note, only HLA-C and HLA-DPB1 mismatch reduced leukemia relapse, and this graft-versus-leukemia effect of HLA-DPB1 was independent of chronic GVHD. HLA-DRB1 and HLA-DQB1 double (DRB1_DQB1) mismatch was revealed to be a significant RR for acute GVHD and mortality, whereas single mismatch was not. Thus, the number of HLA-A, -B, -C, -DPB1, and DRB1_DQB1 mismatches showed a clear-cut risk difference for acute GVHD, whereas the number of mismatches for HLA-A, -B, -C, and DRB1_DQB1 showed the same for mortality. In conclusion, we determined the biological response to HLA locus mismatch in transplant-related immunologic events, and provide a rationale for use of a personalized algorithm for unrelated donor selection.
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Sorror ML, Estey E. Allogeneic hematopoietic cell transplantation for acute myeloid leukemia in older adults. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2014; 2014:21-33. [PMID: 25696831 DOI: 10.1182/asheducation-2014.1.21] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Acute myeloid leukemia (AML) is primarily a disease of the elderly and the numbers of these patients are increasing. Patients ≥60 years of age continue to have poor prognosis. Preliminary results suggest benefit from reduced-intensity allogeneic hematopoietic cell transplantation (HCT) in selected patients 60-80 years of age. However, although patients in this age range comprise >50% of those with AML, they currently constitute only 17% of those offered HCT. In the absence of prospective randomized studies comparing HCT and chemotherapy, the decision to recommend HCT rests on retrospective analyses of the risks of relapse and nonrelapse mortality after each approach. There is strong evidence that pre-HCT comorbidities can predict HCT-related morbidity and mortality. Age alone does not appear predictive and, particularly if the risk of relapse with chemotherapy is high, should not be the sole basis for deciding against HCT. Use of geriatric assessment tools, inflammatory biomarkers, and genetic polymorphism data may further aid in predicting nonrelapse mortality after HCT. Disease status and pretreatment cytogenetics with FLT3-TID, NPM-1, and CEBP-α status are the main factors predicting relapse and these are likely to be supplemented by incorporation of other molecular markers and the level of minimal residual disease after chemotherapy. HLA-matched related and unrelated donor grafts seem preferable to those from other donor sources. Donor age is of no clear significance. Models combining comorbidities with AML risk factors are useful in risk assessment before HCT. In this chapter, we integrated information on AML-specific, HCT-specific, and patient-specific risk factors into a risk-adapted approach to guide decisions about HCT versus no HCT.
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Affiliation(s)
- Mohamed L Sorror
- Clinical Research Division, Fred Hutchinson Cancer Research Center, and Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Elihu Estey
- Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
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van Rood JJ, Claas FH, Brand A, Tilanus MG, van Kooten C. Half a century of Dutch transplant immunology. Immunol Lett 2014; 162:145-9. [DOI: 10.1016/j.imlet.2014.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Sorror ML, Storb RF, Sandmaier BM, Maziarz RT, Pulsipher MA, Maris MB, Bhatia S, Ostronoff F, Deeg HJ, Syrjala KL, Estey E, Maloney DG, Appelbaum FR, Martin PJ, Storer BE. Comorbidity-age index: a clinical measure of biologic age before allogeneic hematopoietic cell transplantation. J Clin Oncol 2014; 32:3249-56. [PMID: 25154831 PMCID: PMC4178523 DOI: 10.1200/jco.2013.53.8157] [Citation(s) in RCA: 295] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Age has long been used as a major factor for assessing suitability for allogeneic hematopoietic cell transplantation (HCT). The HCT-comorbidity index (HCT-CI) was developed as a measure of health status to predict mortality risk after HCT. Whether age, comorbidities, or both should guide decision making for HCT is unknown. PATIENTS AND METHODS Data from 3,033 consecutive recipients of HLA-matched grafts from five institutions contributed to this analysis. Patients were randomly divided into a training set to develop weights for age intervals and a validation set to assess the performance of prognostic models. RESULTS In the training set, patients age 20 to 39 years, 40 to 49 years, 50 to 59 years, and ≥ 60 years had hazard ratios for nonrelapse mortality (NRM) of 1.21 (P = .29), 1.48 (P = .04), 1.75 (P = .004), and 1.84 (P = .005), respectively, compared with those age younger than 20 years. Consequently, age ≥ 40 years was assigned a weight of 1 to be added to the HCT-CI to constitute a composite comorbidity/age index. In the validation set, the composite comorbidity/age score had statistically significantly higher c-statistic estimates for prediction of NRM (0.664 v 0.556; P < .001) and survival (0.682 v 0.560; P < .001) compared with age, respectively. Patients with comorbidity/age scores of 0 to 2 had comparable mortality risks regardless of conditioning regimens. Patients with scores of 3 to 4 and ≥ 5 had statistically significant higher mortality risks after high-dose versus nonmyeloablative regimens. CONCLUSION Age is a poor prognostic factor. The proposed composite measure allows integration of both comorbidities and age into clinical decision making and comparative-effectiveness research of HCT.
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Affiliation(s)
- Mohamed L Sorror
- Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO.
| | - Rainer F Storb
- Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO
| | - Brenda M Sandmaier
- Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO
| | - Richard T Maziarz
- Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO
| | - Michael A Pulsipher
- Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO
| | - Michael B Maris
- Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO
| | - Smita Bhatia
- Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO
| | - Fabiana Ostronoff
- Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO
| | - H Joachim Deeg
- Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO
| | - Karen L Syrjala
- Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO
| | - Elihu Estey
- Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO
| | - David G Maloney
- Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO
| | - Frederick R Appelbaum
- Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO
| | - Paul J Martin
- Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO
| | - Barry E Storer
- Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO
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Graft-versus-host disease biomarkers: omics and personalized medicine. Int J Hematol 2014; 98:275-92. [PMID: 23959582 DOI: 10.1007/s12185-013-1406-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 07/29/2013] [Indexed: 02/03/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the most effective form of tumor immunotherapy available to date and the frequency of transplants continues to increase worldwide. However, while allo-HSCT usually induces a beneficial graft-versus leukemia effect, a major source of morbidity and mortality following allo-HSCT is graft-versus-host disease (GVHD). Currently available diagnostic and staging tools frequently fail to identify those at higher risk for GVHD morbidity, treatment unresponsiveness, and death. Furthermore, there are shortcomings in the risk stratification of patients before GVHD clinical signs develop. In parallel, recent years have been characterized by an explosive evolution of omics technologies, largely due to technological advancements in chemistry, engineering, and bioinformatics. Building on these opportunities, plasma biomarkers have been identified and validated as promising diagnostic and prognostic tools for acute GVHD. This review summarizes current information on the types of GVHD biomarkers, the omics tools used to identify them, the biomarkers currently validated as acute GVHD markers, and future recommendations for incorporating biomarkers into new grading algorithms for risk-stratifying patients and creating more personalized treatment courses. Future directions will include randomized evaluations of these biomarkers in multicenter prospective studies while extending on the need for biomarkers of chronic GVHD.
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Thoma MD, Glejf J, Jacob E, Huneke TJ, DeCook LJ, Johnson ND, Patnaik MM, Litzow MR, Hogan WJ, Newell LF, Chandran R, Porrata LF, Holtan SG. Impact of clinical factors and allograft leukocyte content on post-transplant lymphopenia, monocytopenia, and survival in patients undergoing allogeneic peripheral blood haematopoietic cell transplant. BMC HEMATOLOGY 2014; 14:14. [PMID: 25221674 PMCID: PMC4161916 DOI: 10.1186/2052-1839-14-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 08/27/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND We have previously shown that lymphopenia and monocytopenia at 2-3 months post-allogeneic haematopoietic cell transplant (HCT) is associated with poor survival in recipients of both myeloablative and reduced intensity conditioning regimens. It is not known whether the graft leukocyte content has a role in early lymphocyte and monocyte recovery following allogeneic T-cell replete peripheral blood HCT. METHODS Haematologic recovery data, including absolute lymphocyte and monocyte counts (ALC and AMC, respectively) at day +15, +30, +60, and +100, and outcomes data were pooled from two prior independent cohorts, and parameters were correlated with leukocyte graft content in those individuals receiving peripheral blood progenitor cell grafts. 216 consecutive patients from 2001-2010 were included in the analysis. RESULTS Neither infused allograft lymphocyte, monocyte, granulocyte, nor CD34+ cell number per kilogram recipient body weight correlated with haematologic recovery parameters or overall survival in this cohort. Prognostic factors for overall survival based on multivariate analysis were as expected from the results of the previous independent cohorts and included severity of chronic GVHD (p < 0.001), development of post-transplant relapse (p = 0.001), day +60 AMC > 0.3 x 10(9) cells/L (p = 0.0015), and day +100 ALC > 0.3 x 10(9) cells/L (p < 0.001). Low monocyte and lymphocyte counts at the day +60 and day +100 time points were significantly associated with acute GVHD and/or CMV viraemia. CONCLUSIONS This study suggests that graft cell count does not influence post-transplant monocyte and lymphocyte recovery following T-cell replete allogeneic peripheral blood HCT. Post-transplant complications such as acute GVHD and/or CMV viraemia negatively influenced monocyte and lymphocyte recovery, and hence the survival. Further studies aimed at understanding the mechanisms behind sustained lymphopenia and monocytopenia post-transplant are needed.
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Affiliation(s)
- Mary D Thoma
- Department of Medicine, Division of Hematology, Mayo Clinic Graduate School of Medicine, Rochester, MN USA
| | - Jennifer Glejf
- Department of Pathology and Laboratory Medicine, Mayo Clinic Graduate School of Medicine, Rochester, MN USA
| | - Eapen Jacob
- Department of Pathology and Laboratory Medicine, Mayo Clinic Graduate School of Medicine, Rochester, MN USA
| | - Tanya J Huneke
- Department of Medicine, Division of Hematology, Mayo Clinic Graduate School of Medicine, Rochester, MN USA
| | - Lori J DeCook
- Department of Medicine, Division of Hematology, Mayo Clinic Graduate School of Medicine, Phoenix, AZ USA
| | - Nicci D Johnson
- Department of Medicine, Division of Hematology, Mayo Clinic Graduate School of Medicine, Rochester, MN USA
| | - Mrinal M Patnaik
- Department of Medicine, Division of Hematology, Mayo Clinic Graduate School of Medicine, Rochester, MN USA
| | - Mark R Litzow
- Department of Medicine, Division of Hematology, Mayo Clinic Graduate School of Medicine, Rochester, MN USA
| | - William J Hogan
- Department of Medicine, Division of Hematology, Mayo Clinic Graduate School of Medicine, Rochester, MN USA
| | - Laura F Newell
- Center for Hematologic Malignancies, Knight Cancer Institute, Oregon Health & Science University, Portland, OR USA
| | | | - Luis F Porrata
- Department of Medicine, Division of Hematology, Mayo Clinic Graduate School of Medicine, Rochester, MN USA
| | - Shernan G Holtan
- Department of Medicine, Division of Hematology, Mayo Clinic Graduate School of Medicine, Rochester, MN USA ; Center for Hematologic Malignancies, Knight Cancer Institute, Oregon Health & Science University, Portland, OR USA ; Blood and Marrow Transplant Program, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455 USA
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37
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Sorror ML, Appelbaum FR. Risk assessment before allogeneic hematopoietic cell transplantation for older adults with acute myeloid leukemia. Expert Rev Hematol 2013; 6:547-62. [PMID: 24083472 DOI: 10.1586/17474086.2013.827418] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Acute myeloid leukemia (AML) most commonly affects patients older than 60 years. Outcomes of treatment of older AML patients have been poor. The advent of reduced-intensity conditioning (RIC) regimens made allogeneic hematopoietic cell transplantation (HCT) an available treatment option with curative intent for older AML patients. Because older patients are often excluded from clinical trials, little is known about the stratification of their risks before allogeneic HCT. While recent studies of RIC and allogeneic HCT have shown little impact of age on outcomes, other variables such as the recipient health status and the AML disease status and chromosomal aberrations have proven to be of prognostic significance. Here, the authors review recent studies of allogeneic HCT for older patients with AML with detailed evaluation of risk factors for relapse as well as non-relapse mortality. The authors have integrated the currently available information on transplant risks into a five-category risk-benefit system that could aid in the decision-making in this patient population.
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Affiliation(s)
- Mohamed L Sorror
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Seattle WA 98109-1024, USA
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38
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Mendolia F, Klein JP, Petersdorf EW, Malkki M, Wang T. Comparison of statistics in association tests of genetic markers for survival outcomes. Stat Med 2013; 33:828-44. [PMID: 24105914 DOI: 10.1002/sim.5982] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 08/21/2013] [Indexed: 11/07/2022]
Abstract
Computationally efficient statistical tests are needed in association testing of large scale genetic markers for survival outcomes. In this study, we explore several test statistics based on the Cox proportional hazards model for survival data. First, we consider the classical partial likelihood-based Wald and score tests. A revised way to compute the score statistics is explored to improve the computational efficiency. Next, we propose a Cox-Snell residual-based score test, which allows us to handle the controlling variables more conveniently. We also illustrated the incorporation of these three tests into a permutation procedure to adjust for the multiple testing. In addition, we examine a simulation-based approach proposed by Lin (2005) to adjust for multiple testing. We presented the comparison of these four statistics in terms of type I error, power, family-wise error rate, and computational efficiency under various scenarios via extensive simulation.
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Affiliation(s)
- Franco Mendolia
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, 53226, U.S.A
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39
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Morishima Y, Kawase T, Malkki M, Morishima S, Spellman S, Kashiwase K, Kato S, Cesbron A, Tiercy JM, Senitzer D, Velardi A, Petersdorf EW. Significance of ethnicity in the risk of acute graft-versus-host disease and leukemia relapse after unrelated donor hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2013; 19:1197-203. [PMID: 23747601 PMCID: PMC3972059 DOI: 10.1016/j.bbmt.2013.05.020] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 05/29/2013] [Indexed: 12/16/2022]
Abstract
The significance of patient and donor ethnicity on risk of acute graft-versus-host disease (GVHD) and disease relapse after unrelated donor hematopoietic cell transplantation (HCT) is not known. A total of 4335 patient-donor pairs from the International Histocompatibility Working Group in HCT met the following 3 criteria: (1) HLA-A, -B, -C, -DRB1, and -DQB1 allele matched donor, (2) diagnosis of leukemia, and (3) non-T cell depleted GVHD prophylaxis. Posttransplantation risks of acute GVHD and leukemia relapse were defined in Asian/Pacific Islander, white, African American, Hispanic, and Native American patients that underwent transplantation from donors with the same self-described background. Asian patients had a significantly lower incidence of acute GVHD (Japanese patients: 40.0% grades II to IV and 15.3% grades III to IV; non-Japanese Asian patients: 42.1% grades II to IV and 15.7% grades III to IV) compared with white patients (56.5% grades II to IV and 22.6% grades III to IV) (P < .001). The hazard ratio of acute GVHD for white patients was significantly higher than for Japanese patients. Unexpectedly, the hazard ratio of leukemia relapse in white patients with early disease status was also significantly higher than that in Japanese patients. These results provide a platform for future investigation into the genetic factors for unrelated donor HCT and clinical implications of diverse ethnic background.
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Affiliation(s)
- Yasuo Morishima
- Japan Marrow Donor Program, Tokyo, Japan; Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan.
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40
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Cao H, Wu J, Wang Y, Jiang H, Zhang T, Liu X, Xu Y, Liang D, Gao P, Sun Y, Gifford B, D’Ascenzo M, Liu X, Tellier LCAM, Yang F, Tong X, Chen D, Zheng J, Li W, Richmond T, Xu X, Wang J, Li Y. An integrated tool to study MHC region: accurate SNV detection and HLA genes typing in human MHC region using targeted high-throughput sequencing. PLoS One 2013; 8:e69388. [PMID: 23894464 PMCID: PMC3722289 DOI: 10.1371/journal.pone.0069388] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 06/07/2013] [Indexed: 12/05/2022] Open
Abstract
The major histocompatibility complex (MHC) is one of the most variable and gene-dense regions of the human genome. Most studies of the MHC, and associated regions, focus on minor variants and HLA typing, many of which have been demonstrated to be associated with human disease susceptibility and metabolic pathways. However, the detection of variants in the MHC region, and diagnostic HLA typing, still lacks a coherent, standardized, cost effective and high coverage protocol of clinical quality and reliability. In this paper, we presented such a method for the accurate detection of minor variants and HLA types in the human MHC region, using high-throughput, high-coverage sequencing of target regions. A probe set was designed to template upon the 8 annotated human MHC haplotypes, and to encompass the 5 megabases (Mb) of the extended MHC region. We deployed our probes upon three, genetically diverse human samples for probe set evaluation, and sequencing data show that ∼97% of the MHC region, and over 99% of the genes in MHC region, are covered with sufficient depth and good evenness. 98% of genotypes called by this capture sequencing prove consistent with established HapMap genotypes. We have concurrently developed a one-step pipeline for calling any HLA type referenced in the IMGT/HLA database from this target capture sequencing data, which shows over 96% typing accuracy when deployed at 4 digital resolution. This cost-effective and highly accurate approach for variant detection and HLA typing in the MHC region may lend further insight into immune-mediated diseases studies, and may find clinical utility in transplantation medicine research. This one-step pipeline is released for general evaluation and use by the scientific community.
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Affiliation(s)
- Hongzhi Cao
- Science and Technology Department, BGI-Shenzhen, Shenzhen, China
- Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Jinghua Wu
- Science and Technology Department, BGI-Shenzhen, Shenzhen, China
| | - Yu Wang
- Science and Technology Department, BGI-Shenzhen, Shenzhen, China
| | - Hui Jiang
- Science and Technology Department, BGI-Shenzhen, Shenzhen, China
- Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Tao Zhang
- Science and Technology Department, BGI-Shenzhen, Shenzhen, China
| | - Xiao Liu
- Science and Technology Department, BGI-Shenzhen, Shenzhen, China
- Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Yinyin Xu
- Science and Technology Department, BGI-Shenzhen, Shenzhen, China
| | - Dequan Liang
- Science and Technology Department, BGI-Shenzhen, Shenzhen, China
| | - Peng Gao
- Science and Technology Department, BGI-Shenzhen, Shenzhen, China
| | - Yepeng Sun
- Science and Technology Department, BGI-Shenzhen, Shenzhen, China
| | - Benjamin Gifford
- Roche NimbleGen, Inc., Madison, Wisconsin, United States of America
| | - Mark D’Ascenzo
- Roche NimbleGen, Inc., Madison, Wisconsin, United States of America
| | - Xiaomin Liu
- Science and Technology Department, BGI-Shenzhen, Shenzhen, China
| | - Laurent C. A. M. Tellier
- Science and Technology Department, BGI-Shenzhen, Shenzhen, China
- Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Fang Yang
- Science and Technology Department, BGI-Shenzhen, Shenzhen, China
| | - Xin Tong
- Science and Technology Department, BGI-Shenzhen, Shenzhen, China
| | - Dan Chen
- Science and Technology Department, BGI-Shenzhen, Shenzhen, China
| | - Jing Zheng
- Science and Technology Department, BGI-Shenzhen, Shenzhen, China
| | - Weiyang Li
- Science and Technology Department, BGI-Shenzhen, Shenzhen, China
| | - Todd Richmond
- Roche NimbleGen, Inc., Madison, Wisconsin, United States of America
| | - Xun Xu
- Science and Technology Department, BGI-Shenzhen, Shenzhen, China
| | - Jun Wang
- Science and Technology Department, BGI-Shenzhen, Shenzhen, China
- Department of Biology, University of Copenhagen, Copenhagen, Denmark
- King Abdulaziz University, Jeddah, Saudi Arabia
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- * E-mail: (YL); (J. Wang)
| | - Yingrui Li
- Science and Technology Department, BGI-Shenzhen, Shenzhen, China
- * E-mail: (YL); (J. Wang)
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41
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Abstract
Acute graft-versus-host disease (GVHD) afflicts as much as 80% of all patients who receive an unrelated donor hematopoietic cell transplant (HCT) for the treatment of blood disorders, even with optimal donor HLA matching and use of prophylactic immunosuppressive agents. Of patients who develop acute GVHD, many are at risk for chronic GVHD and bear the burden of considerable morbidity and lowered quality of life years after transplantation. The immunogenetic basis of GVHD has been the subject of intensive investigation, with the classic HLA genetic loci being the best-characterized determinants. Recent information on the major histocompatibility complex (MHC) region of chromosome 6 as an important source of untyped genetic variation has shed light on novel GVHD determinants. These data open new paradigms for understanding the genetic basis of GVHD.
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42
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Petersdorf EW, Malkki M, Horowitz MM, Spellman SR, Haagenson MD, Wang T. Mapping MHC haplotype effects in unrelated donor hematopoietic cell transplantation. Blood 2013; 121:1896-905. [PMID: 23305741 PMCID: PMC3591807 DOI: 10.1182/blood-2012-11-465161] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 12/21/2012] [Indexed: 01/09/2023] Open
Abstract
Life-threatening risks associated with HLA-mismatched unrelated donor hematopoietic cell transplantation limit its general application for the treatment of blood diseases. The increased risks might be explained by undetected genetic variation within the highly polymorphic major histocompatibility complex (MHC) region. We retrospectively assessed each of 1108 MHC region single nucleotide polymorphisms (SNPs) in 2628 patients and their HLA-mismatched unrelated donors to determine whether SNPs are associated with the risk of mortality, disease-free survival, transplant-related mortality, relapse, and acute and chronic graft-versus-host disease (GVHD). Multivariate analysis adjusted for HLA mismatching and nongenetic variables associated with each clinical end point. Twelve SNPs were identified as transplantation determinants. SNP-associated risks were conferred by either patient or donor SNP genotype or by patient-donor SNP mismatching. Risks after transplantation increased with increasing numbers of unfavorable SNPs. SNPs that influenced acute GVHD were independent of those that affected risk of chronic GVHD and relapse. HLA haplotypes differed with respect to haplotype content of (un)favorable SNPs. Outcome after HLA-mismatched unrelated donor transplantation is influenced by MHC region variation that is undetected with conventional HLA typing. Knowledge of the SNP content of HLA haplotypes provides a means to estimate risks prior to transplantation and to lower complications through judicious selection of donors with favorable MHC genetics.
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Affiliation(s)
- Effie W Petersdorf
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
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43
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Petersdorf EW, Malkki M, Hsu K, Bardy P, Cesbron A, Dickinson A, Dubois V, Fleischhauer K, Kawase T, Madrigal A, Morishima Y, Shaw B, Spellman S, Spierings E, Stern M, Tiercy JM, Velardi A, Gooley T. 16th IHIW: international histocompatibility working group in hematopoietic cell transplantation. Int J Immunogenet 2012; 40:2-10. [PMID: 23279968 DOI: 10.1111/iji.12022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 10/22/2012] [Accepted: 10/23/2012] [Indexed: 11/28/2022]
Abstract
The International Histocompatibility Working Group is a collaborative international effort to understand the HLA and non-HLA genetics of the transplantation barrier. The Working Group is comprised of experts in the fields of histocompatibility and immunogenetics, hematopoietic cell transplantation and outcomes research. Data for 25 855 unrelated donor transplants were submitted in support of research studies for the 16th International Histocompatibility Workshop. Active investigation is in progress in seven key areas: the impact of HLA matching, role of race and ethnicity, identification of permissible HLA mismatches, haplotype-associated determinants, minor histocompatibility antigens, immune response genes and KIR genetics. New hypotheses for the 16th workshop were developed for immunogenetic studies in cord blood and haploidentical-related donor transplantation.
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Affiliation(s)
- E W Petersdorf
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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44
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Abstract
Graft-versus-host disease (GVHD) is a potentially life-threatening complication of allogeneic hematopoietic cell transplantation. Many genes are presumed to be involved in GVHD, but the best characterized genetic system is that of the human major histocompatibility complex (MHC) located on chromosome 6. Among the hundreds of genes located within the MHC region, the best known and characterized are the classical HLA genes, HLA-A, C, B, DRB1, DQB1, and DPB1. They play a fundamental role in T cell immune responses, and HLA-A, C, and B also function as ligands for the natural killer cell immunoglobulin-like receptors involved in innate immunity. This review highlights the state-of-the art in the field of histocompatibility and immunogenetics of the MHC with respect to genetic risk factors for GVHD.
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45
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Abstract
In transplantation of hematopoietic stem cells (HSCs) from unrelated donors a high HLA compatibility level decreases the risk of acute graft-versus-host disease and mortality. The diversity of the HLA system at the allelic and haplotypic level and the heterogeneity of HLA typing data of the registered donors render the search process a complex task. This paper summarizes our experience with a search algorithm that includes at the start of the search a probability estimate (high/intermediate/low) to identify a HLA-A, B, C, DRB1, DQB1-compatible donor (a 10/10 match). Based on 2002–2011 searches about 30% of patients have a high, 30% an intermediate, and 40% a low probability search. Search success rate and duration are presented and discussed in light of the experience of other centers. Overall a 9-10/10 matched HSC donor can now be identified for 60–80% of patients of European descent. For high probability searches donors can be selected on the basis of DPB1-matching with an estimated success rate of >40%. For low probability searches there is no consensus on which HLA incompatibilities are more permissive, although HLA-DQB1 mismatches are generally considered as acceptable. Models for the discrimination of more detrimental mismatches based on specific amino acid residues rather than specific HLA alleles are presented.
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