Human leukocyte antigen disparities reduce relapse after hematopoietic stem cell transplantation in children with juvenile myelomonocytic leukemia: A single-center retrospective study from China.

Abstract

HSCT is the only proven curative therapy for JMML. Matching donor and recipient HLA alleles is considered optimal to reduce the risk of GVHD after HSCT but is not always possible. Only a limited number of studies have compared the influence of HLA disparities on HSCT outcomes for patients with JMML. We conducted a retrospective study among 47 children with JMML who received related or unrelated unmanipulated HSCT (March 2010-October 2018). Among our participants, 27 (57.4%) donor-recipient pairs had 0-1 HLA disparities (Group 1: HLA-matched or ≤1 allele/antigen mismatch donor) and 20 (42.6%) had ≥2 HLA disparities (Group 2: 2-3 mismatched/haploidentical donors). The median follow-up period was 26.0months (range: 1-105months), and the 5-year probabilities of DFS and RI for the whole cohort were 54.6±7.7% and 34.8±15.0%, respectively. Compared to Group 1, Group 2 patients had a significantly lower RI (5.3±10.5% vs 55.5±20.9%, P˂.001), though similar rates of grade II-IV acute GVHD (60.0±22.4% vs 33.3±18.2%, P=.08), grade III-IV acute GVHD (25.0±19.5% vs 7.4±10.1%, P=.08), chronic GVHD (30.0±20.9% vs 34.9±18.8%, P=.85), NRM (20.0±18.0% vs 3.9±7.7%, P=.07), and DFS (74.4±9.9% vs 41.3±10.0%, P=.08). Disease relapse remains the major cause of treatment failure in JMML patients, especially in patients receiving HLA-matched and limited HLA-mismatched HSCT. Our findings suggest that donor-recipient HLA disparities may improve the outcome of HSCT in children with JMML.