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Impact of HLA-mismatched unrelated transplantation in patients with adult T-cell leukemia/lymphoma

Bone Marrow Transplantation volume 58, pages 980–990 (2023)Cite this article

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Abstract

This Japanese nationwide retrospective study investigated the impact of HLA-mismatched unrelated transplantation for adult T-cell leukemia-lymphoma (ATL) patients who received transplantation between 2000 and 2018. We compared 6/6 antigen-matched related donor (MRD), 8/8 allele-matched unrelated donor (8/8MUD), and 1 allele-mismatched unrelated donor (7/8MMUD) in the graft-versus-host direction. We included 1191 patients; 449 (37.7%) were in the MRD group, 466 (39.1%) in the 8/8MUD group, and 276 (23.7%) in the 7/8MMUD group. In the 7/8MMUD group, 97.5% of patients received bone marrow transplantation, and no patients received post-transplant cyclophosphamide. The cumulative incidences of non-relapse mortality (NRM) and relapse at 4 years, and the probabilities of overall survival at 4 years in the MRD group were 24.7%, 44.4%, 37.5%, in the 8/8MUD group were 27.2%, 38.2%, and 37.9%, and in the 7/8MMUD group were 34.0%, 34.4%, and 35.3%, respectively. The 7/8MMUD group had a higher risk of NRM (hazard ratio (HR) 1.50 [95% CI, 1.13–1.98; P = 0.005]) and a lower risk of relapse (HR 0.68 [95% CI, 0.53–0.87; P = 0.003]) than the MRD group. The donor type was not a significant risk factor for overall mortality. These data suggest that 7/8MMUD is an acceptable alternative donor when an HLA-matched donor is unavailable.

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Fig. 1: Cumulative incidences of GVHD.
Fig. 2: Cumulative incidences of NRM and relapse, and the probability of OS and GRFS.
Fig. 3: Impact of donor type on outcomes by each factor, comparing the 8/8MUD and 7/8MMUD groups.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

This research was supported by JSPS KAKENHI Grant Number 19K17861 and 22K16305, and by the Practical Research for Innovative Cancer Control Program of the Japan Agency for Medical Research and Development (20ck0106616h0001). We are grateful to the ATL Working Group of the JSTCT and the data management committee of TRUMP by the JSTCT and the JDCHCT for helping with this study.

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Authors and Affiliations

  1. Department of Hematology, Kumamoto University Hospital, Kumamoto, Japan

    Yoshitaka Inoue

  2. Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan

    Satoko Morishima & Shouhei Tomori

  3. Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan

    Koji Kato & Yasuo Mori

  4. Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan

    Ayumu Ito & Takahiro Fukuda

  5. Department of Hematology, Imamura General Hospital, Kagoshima, Japan

    Nobuaki Nakano

  6. Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan

    Takuro Kuriyama

  7. Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan

    Toshiro Kawakita

  8. Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan

    Youko Suehiro

  9. Department of Hematology, Nagasaki University Hospital, Nagasaki, Japan

    Hidehiro Itonaga

  10. Department of Hematology, Oita Prefectural Hospital, Oita, Japan

    Yasuhiko Miyazaki

  11. Department of Hematology, Japanese Red Cross Osaka Hospital, Osaka, Japan

    Kazunori Imada

  12. Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Junya Kanda

  13. Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan

    Tatsuo Ichinohe

  14. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan

    Yoshiko Atsuta

  15. Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan

    Yoshiko Atsuta

  16. Department of Hematology and Rheumatology, Kagoshima University Hospital, Kagoshima, Japan

    Makoto Yoshimitsu

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  1. Yoshitaka Inoue
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ATL Working Group of the Japanese Society for Transplantation and Cellular Therapy

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YI, SM, KK, TF, and MY participated in the research design, data analysis, and writing of this article. AI, NN, TK, TK, YM, YS, HI, YM, KI, ST, JK, TI, and YA participated in writing of the paper.

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Correspondence to Yoshitaka Inoue.

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JK has received honoraria (e.g., lecture fees) from Sanofi. The other authors declare no competing interests.

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Inoue, Y., Morishima, S., Kato, K. et al. Impact of HLA-mismatched unrelated transplantation in patients with adult T-cell leukemia/lymphoma. Bone Marrow Transplant 58, 980–990 (2023). https://doi.org/10.1038/s41409-023-02002-7

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