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