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1. The Rome Transplant Network model compared to the Italian Bone Marrow Donor Registry activity for unrelated donor search process and transplant efficiency for hematologic malignancy.

Author

Picardi A, Arcese W, Pollichieni S, Di Piazza F, Mangione I, Gallina AM, Cerretti R, Cudillo L, De Angelis G, Mengarelli A, Dentamaro T, Tirindelli MC, Chierichini A, Ferrari A, Marciano R, Andreani M, Bonifazi F, and Sacchi N

Subjects
Adolescent, Adult, Aged, Female, Histocompatibility Testing, Humans, Italy, Male, Middle Aged, Young Adult, Bone Marrow Transplantation, Hematologic Neoplasms therapy, Registries, Unrelated Donors
Abstract

Background: From 2011 to 2014, a total of 71% of the 3834 patients with hematologic malignancies successfully identified a matched unrelated donor (MUD) through the Italian Bone Marrow Donor Registry (IBMDR), corresponding to a transplant efficiency of 62%., Study Design and Methods: From 2006, the Rome Transplant Network (RTN) followed a hierarchical selection strategy for the alternative donor search: first MUD, second cord blood, and third haploidentical donor. Using a low-resolution HLA, a preliminary query (PQ) was performed in all cases with assignment of good or poor score if more or less than 10 MUDs were identified in Bone Marrow Donors Worldwide. Herein we assessed the utility of PQ and of high-resolution (HR) HLA from the start of the search. Moreover, we compared the donor identification and the transplant efficiency between IBMDR and RTN., Results: At RTN 79% of 417 patients met a good PQ with a 50% MUD identification versus 12.5% with poor PQ. Our policy led to 78 and 74% of alternative donor identification and transplant efficiency, respectively, higher than IBMDR data equal to 71% (p = 0.007) and 62% (p < 0.0001). The timing for donor identification was significantly reduced using HR HLA at the start of the search from 88 to 66 days at IBMDR (p < 0.001) and from 61 to 41 days at RTN (p < 0.001)., Conclusions: Both PQ and HR HLA at the start of the process represents a useful tool to address the search towards the best and timely donor choice. Moreover, establishing a specific donor policy significantly improves the transplant efficiency., (© 2017 The Authors Transfusion published by Wiley Periodicals, Inc. on behalf of AABB.)

Published
2017
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2. Allelic HLA Matching and Pair Origin Are Favorable Prognostic Factors for Unrelated Hematopoietic Stem Cell Transplantation in Neoplastic Hematologic Diseases: An Italian Analysis by the Gruppo Italiano Trapianto di Cellule Staminali e Terapie Cellulari, Italian Bone Marrow Donor Registry, and Associazione Italiana di Immunogenetica e Biologia dei Trapianti

Author

Lucia Farina, Anna Maria Gallina, Paolo Bernasconi, Marco Andreani, Elena Oldani, Mariarosaria Sessa, P Chiusolo, Valeria Miotti, Benedetto Bruno, Francesca Bonifazi, F. Lorentino, Pietro Pioltelli, Mario Luppi, Domenico Russo, Carlo Borghero, Angelo Michele Carella, Attilio Olivieri, Francesco Zallio, William Arcese, Ivana Celeghini, Teresa Lamparelli, G. Papalinetti, Fabio Benedetti, Giuseppe Milone, Stefano Guidi, Alessandro Rambaldi, Sonia Mammoliti, Ursula La Rocca, Franca Fagioli, Simona Pollichieni, Alessandra Picardi, Fabio Ciceri, Luca Vago, Massimo Martino, Ilaria Mangione, Francesca Patriarca, Paola Carluccio, Michela Cerno, Nicoletta Sacchi, Silvia Miccichè, Giorgia Saporiti, Picardi, A., Sacchi, N., Miotti, V., Lorentino, F., Oldani, E., Rambaldi, A., Sessa, M., Bruno, B., Cerno, M., Vago, L., Bernasconi, P., Arcese, W., Benedetti, F., Pioltelli, P., Russo, D., Farina, L., Fagioli, F., Guidi, S., Saporiti, G., Zallio, F., Chiusolo, P., Borghero, C., Papalinetti, G., La Rocca, U., Milone, G., Lamparelli, T., Carella, A. M., Luppi, M., Olivieri, A., Martino, M., Carluccio, P., Celeghini, I., Andreani, M., Gallina, A. M., Patriarca, F., Pollichieni, S., Mammoliti, S., Micciche, S., Mangione, I., Ciceri, F., and Bonifazi, F.

Subjects
Adult, medicine.medical_specialty, medicine.medical_treatment, Lymphocyte, Hematopoietic stem cell transplantation, Human leukocyte antigen, Gastroenterology, Bone Marrow, HLA matching, Italian origin, Unrelated hematopoietic stem cell transplantation, Internal medicine, medicine, Immunology and Allergy, Humans, Cumulative incidence, Registries, Alleles, Transplantation, business.industry, Hematopoietic Stem Cell Transplantation, Retrospective cohort study, Cell Biology, Hematology, Middle Aged, Settore MED/15, Prognosis, Hematologic Diseases, Neoplasm Recurrence, medicine.anatomical_structure, Local, Italy, Molecular Medicine, Methotrexate, Bone marrow, Stem cell, Neoplasm Recurrence, Local, business, medicine.drug
Abstract

HLA molecules are important for immunoreactivity in allogeneic hematopoietic stem cell transplantation (HSCT). The Gruppo Italiano Trapianto di Cellule Staminali e Terapie Cellulari, Italian Bone Marrow Donor Registry, and Associazione Italiana di Immunogenetica e Biologia dei Trapianti promoted a retrospective observational study to evaluate HLA matching and the impact of allelic HLA mismatching and non-HLA factors on unrelated Italian HSCT outcomes. From 2012 to 2015, 1788 patients were enrolled in the study. The average donor age was 29 years and the average recipient age was 49 years. As a conditioning regimen, 71% of the patients received myeloablative conditioning. For GVHD prophylaxis, 76% received either antithymocyte or anti-T lymphocyte globulin, cyclosporine A, and methotrexate. Peripheral blood was the stem cell source in 80%. The median duration of follow-up was 53 months. Regarding HLA matching, 50% of donor-recipient pairs were 10/10 matched, 38% had 1 mismatch, and 12% had 2 or more mismatches. A total of 302 pairs shared Italian origin. Four-year overall survival (OS), progression-free survival, GVHD-free relapse-free survival, and relapse rates were 49%, 40%, 22%, and 34%, respectively. The 4-year NRM was 27%, and the 100-day cumulative incidence of grade ≥II acute GVHD (aGVHD) was 26%. In multivariate analysis, 9/10 and ≤8/10 HLA allele-matched pairs were associated with worse OS (P = .04 and. 007, respectively), NRM (P = .007 and P < .0001, respectively), and grade III-IV aGVHD (P = .0001 and. 01, respectively). Moreover, the incidences of grade II-IV aGVHD (P = .001) and chronic GVHD (P = .002) were significantly lower in Italian pairs. In conclusion, 10/10 HLA matching is a favorable prognostic factor for unrelated HSCT outcome in the Italian population. Moreover, the presence of 2 HLA-mismatched loci was associated with a higher NRM (P < .0001) and grade II-IV aGVHD (P = .006) and a poorer OS (P = .001) compared with 1 HLA-mismatched locus in early or intermediate disease phases. Finally, we found that Italian donor and recipient origin is a favorable prognostic factor for GVHD occurrence.

Published
2021

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