scholarly journals Topical Tacrolimus and Periodontal Therapy in the Management of a Case of Oral Chronic GVHD Characterized by Specific Gingival Localization

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Davide Conrotto ◽  
Roberto Broccoletti ◽  
Paola Carcieri ◽  
Luisa Giaccone ◽  
Paolo G. Arduino
Keyword(s):  
Oral Hygiene ◽  
Myeloid Leukemia ◽  
Chronic Gvhd ◽  
Pharmacological Therapy ◽  
Oral Lesions ◽  
Topical Tacrolimus ◽  
Graft Versus Host ◽  
Oral Gvhd ◽  
Oral Hygiene Instructions ◽  
Root Planning

Background. Chronic graft versus host disease (cGVHD) is a complication following bone marrow transplantation. The oral lesions are difficult to control with a systemic pharmacological therapy.Case Description. A 63-year-old female patient, who underwent an allogeniec transplantation for acute myeloid leukemia, developed a chronic oral and cutaneous GVHD. The patient was treated with topical tacrolimus 0.1%, twice daily for two months, and underwent a protocol of oral hygiene characterized by 3 appointments of scaling, root planning, and daily oral hygiene instructions. The patient showed marked resolution of gingival lesions and a significant improvement of related pain and gingival inflammatory indexes.Clinical Implications. This case report suggests that treatment with topical tacrolimus and professional oral hygiene may be helpful in the management of chronic oral GVHD with severe gingival involvement.

Use of Peripheral Blood Grafts Is Associated with Increased Acute and Chronic Graft-Versus-Host Disease without Improved Survival after Unrelated Donor Transplantation.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 443-443 ◽  
Author(s):  
Mary Eapen ◽  
Michael Haagenson ◽  
Brent Logan ◽  
Dennis Confer ◽  
Mary Horowitz ◽  
...  
Keyword(s):  
Stem Cell ◽  
Treatment Failure ◽  
Graft Versus Host Disease ◽  
Peripheral Blood ◽  
Myeloid Leukemia ◽  
Chronic Gvhd ◽  
Single Locus ◽  
Unrelated Donor ◽  
Host Disease ◽  
Graft Versus Host

Abstract Data from the CIBMTR indicate that approximately 70% of unrelated donor hematopoietic stem cell transplants (HCT) in the U.S. utilize peripheral blood (PB) rather than bone marrow (BM) as a graft source. Comparative studies verifying its benefit, however, are lacking. We, therefore, performed a retrospective analysis comparing the results of 275 unrelated PB and 620 unrelated BM transplants in adults 18–60 years of age with acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), myelodysplastic syndrome (MDS) or chronic myeloid leukemia (CML), transplanted in 2000–2002. 73% of PB grafts were matched at HLA A, B, C (low resolution) and DRB1, 21% were mismatched at a single locus and 6% were mismatched at ≥ 2 loci. 69% of BM grafts were matched, 26% were mismatched at a single locus and 5% were mismatched at ≥ 2 loci. Median follow-up was 24 (range, 6–48) and 34 (range, 6–54) months for PB and BM recipients, respectively. Groups were similar except PB recipients were less likely to have CML, were more likely to have MDS and were transplanted more recently. Incidences of neutrophil recovery (95% vs. 90% at day 100, p=0.01) and platelets ≥20,000/ul (81% vs. 66%, at 1-year, p <0.0001) were significantly higher after PB than BM transplants. Incidences of grades 2–4 but not grades 3–4 acute graft-versus-host disease (GVHD) were significantly higher after PB than BM transplants (56% vs.45%, at day 100, p=0.003). Chronic GVHD was also significantly higher after PB transplants (54% vs. 39%, at 3 years, p<0.0001). Despite higher rates of grade 2–4 acute and chronic GVHD after PB transplantation, incidence of relapse was similar in the two groups for both early and advanced leukemia. In multivariate analysis, risks of treatment-related mortality (TRM), treatment failure (relapse or death) and overall mortality during the first 9 months after transplantation were similar. However, among patients surviving the first 9 months, subsequent risks of TRM (relative risk [RR] 1.90, 95% confidence interval [CI], 1.14–3.17, p=0.01) and treatment failure (RR 1.60, 95% CI 1.06–2.44, p=0.03) were significantly higher in the PB cohort. Three-year adjusted (from multivariate models) probabilities of leukemia-free survival were 29% and 31%, p=0.5, after PB and BM transplantation, respectively; corresponding probabilities of overall survival were 31% and 32%, p=0.8. While these data do not indicate a survival advantage with either stem cell source by disease or risk group, PB is associated with earlier engraftment. This advantage is offset by higher rates of grades 2–4 acute and chronic GVHD, leading to a higher risk of late adverse events. Randomized clinical trials are necessary to better define the relative risks and benefits of PB in the setting of unrelated donor HCT.

Association of Graft-Versus-Host Disease and Immunosuppressive Treatment with Risks of Recurrent Malignancy and Mortality After Allogeneic Hematopoietic Cell Transplantation

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 218-218
Author(s):  
Yoshihiro Inamoto ◽  
Mary E.D. Flowers ◽  
Stephanie J. Lee ◽  
Paul A. Carpenter ◽  
Edus H. Warren ◽  
...  
Keyword(s):  
Myeloid Leukemia ◽  
Acute Gvhd ◽  
Hematopoietic Cell Transplantation ◽  
Chronic Gvhd ◽  
Immunosuppressive Treatment ◽  
Time Varying ◽  
Graft Versus Host ◽  
Recurrent Malignancy ◽  
Time Varying Covariates

Abstract Abstract 218 Background: Graft-versus-leukemia (GVL) effects are closely associated with graft-versus-host disease (GVHD) after allogeneic hematopoietic cell transplantation (HCT). In a reexamination of GVL effects, we evaluated acute and chronic GVHD defined by NIH consensus criteria and immunosuppressive treatment (IST) as risk factors for recurrent malignancy after HCT. Patients and methods: We analyzed a cohort of 2656 consecutive patients with acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myeloid leukemia (CML), myelodysplastic syndrome (MDS) or myeloproliferative neoplasms (MPN) who received allogeneic HCT after high-intensity conditioning between 1992 and 2005. The onset of NIH chronic GVHD was ascertained by retrospective chart review using follow-up information obtained by our Long Term Follow Up clinic. Rates and hazards of recurrent malignancy and mortality were analyzed according to GVHD and IST as time-varying covariates. To illustrate the effect of time-varying covariates, we calculated the rate of recurrent malignancy per patient-year according to prior GVHD within sequential 90-day intervals after HCT. Cox proportional hazard models were adjusted for potential factors affecting outcomes. Results: The median patient age at HCT was 39 years (range, 0 to 71 years). Donors were HLA-identical relatives (n=1088), HLA-matched unrelated volunteers (n=912), HLA-mismatched relatives (n=243), and HLA-mismatched unrelated volunteers (n=413). GVHD prophylaxis was mostly cyclosporine and methotrexate (n=1885, 71%). Relapse rates per patient-year declined from 3 months until at least 36 months after HCT for patients with prior acute GVHD or NIH chronic GVHD (Figure). Patients without prior GVHD showed a much less pronounced decline between 12 and 30 months after HCT. Adjusted Cox analysis showed that acute GVHD and NIH chronic GVHD were associated with statistically similar reductions in risk of late recurrent malignancy beyond 18 months after HCT, with no incremental effect of chronic GVHD in patients with prior acute GVHD (Table 1). GVL effects were demonstrable in patients with CML or AML but not in those with ALL or MDS/MPN. Discontinuation of IST was associated with a decreased risk of recurrent malignancy among patients without prior GVHD but not among those with prior GVHD (Table 2). Grades III–IV acute GVHD and NIH chronic GVHD with prior acute GVHD were associated with a statistically significant increase in risk of early mortality between 3 and 18 months, but grade II acute GVHD and NIH chronic GVHD without prior acute GVHD were not. Conclusion: Both acute and NIH chronic GVHD are associated with potent GVL effects, but NIH chronic GVHD does not confer any incremental benefit after acute GVHD. Withdrawal of IST was associated with a reduction in risk of recurrent malignancy in patients without prior GVHD. Analyses of GVL effects should account for time from HCT, the history of GVHD, type of malignancy and IST. Immune manipulations such as prophylactic donor lymphocyte infusion or early withdrawal of IST may represent reasonable approaches to decrease the risk of recurrent malignancy in patients without prior GVHD, if the risk of GVHD could be minimized. Disclosures: No relevant conflicts of interest to declare.

Sustained Remissions of High-Risk Acute Myeloid Leukemia and Myelodysplastic Syndrome After Reduced-Intensity Conditioning Allogeneic Hematopoietic Transplantation: Chronic Graft-Versus-Host Disease Is the Strongest Factor Improving Survival

2008 ◽  
Vol 26 (4) ◽  
pp. 577-584 ◽  
Author(s):  
David Valcárcel ◽  
Rodrigo Martino ◽  
Dolores Caballero ◽  
Jesus Martin ◽  
Christelle Ferra ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
High Risk ◽  
Myelodysplastic Syndrome ◽  
Graft Versus Host Disease ◽  
Myeloid Leukemia ◽  
Chronic Gvhd ◽  
Reduced Intensity Conditioning ◽  
Graft Versus Host ◽  
Reduced Intensity ◽  
Acute Myeloid

Purpose Reduced-intensity conditioning (RIC) for allogeneic stem-cell transplantation (allo-SCT) reduces nonrelapse mortality (NRM). This reduction makes it possible for patients who are ineligible for high-dose myeloablative conditioning allo-SCT to benefit from graft-versus-leukemia reaction. In this multicenter, prospective study of patients with acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS), we investigated the efficacy of RIC allo-SCT from a human leukocyte antigen–identical sibling by using a regimen that uses fludarabine and busulfan. Patients and Methods Ninety-three patients with AML (n = 59) and MDS (n = 34) were included, and the median age was of 53 years. Follow-up for survivors was 43 months (range, 3 to 89 months). The conditioning regimen consisted of fludarabine (150 mg/m2) and oral busulfan (8 to 10 mg/kg). All except one patient received mobilized peripheral blood stem cells. Graft-versus-host disease (GVHD) prophylaxis consisted of cyslosporine and methotrexate or mycophenolate mofetil. Results The 100-day, 1-year, and 4-year incidences of NRM were 8, 16%, and 21%, respectively. The 1- and 4-year relapse cumulative incidences were 23% and 37%, respectively, and leukemia recurrence was the main cause of death. The 4-year disease-free survival (DFS) and overall survival (OS) rates were 43% and 45%, respectively. The 4-year cumulative incidence of chronic GVHD was 53% (45% extensive), and its development was the major factor associated with lower relapse incidence and improved DFS and OS. Conclusion Our results confirm the capacity of this RIC regimen to obtain long-term remissions in patients ineligible for a conventional allo-SCT. The results suggest an important role of the development of chronic GVHD in reducing relapse and improving DFS and OS.

scholarly journals Comparative Outcomes of Donor Graft CD34+ Selection and Immune Suppressive Therapy As Graft-Versus-Host Disease Prophylaxis for Patients With Acute Myeloid Leukemia in Complete Remission Undergoing HLA-Matched Sibling Allogeneic Hematopoietic Cell Transplantation

2012 ◽  
Vol 30 (26) ◽  
pp. 3194-3201 ◽  
Author(s):  
Marcelo C. Pasquini ◽  
Steven Devine ◽  
Adam Mendizabal ◽  
Lindsey R. Baden ◽  
John R. Wingard ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Graft Versus Host Disease ◽  
Immune Suppression ◽  
Graft Rejection ◽  
Myeloid Leukemia ◽  
Hematopoietic Cell Transplantation ◽  
Chronic Gvhd ◽  
Graft Versus Host ◽  
Cd34 Selection ◽  
Acute Myeloid

Purpose T-cell depletion (TCD) reduces the incidence of graft-versus-host disease (GVHD) after hematopoietic cell transplantation (HCT). However, concerns about relapse, graft rejection, and variability in technique have limited the widespread application of this approach. Patients and Methods Outcomes of 44 patients receiving HLA-identical sibling TCD grafts using a uniform technique for CD34+ selection as the sole form of immune suppression were compared with outcomes of 84 patients receiving T-replete grafts and pharmacologic immune suppression therapy (IST). Results Groups were similar, except for fewer men (36% with TCD v 56% with IST) and more frequent use of radiation-containing regimens (100% with TCD v 50% with IST) in the CD34-selected TCD cohort. The proportion of patients with neutrophil engraftment at day 28 was similar (96% with IST and 100% with TCD grafts). The 100-day rates of grade 2 to 4 acute GVHD were 39% and 23% with IST and TCD grafts, respectively (P = .07). Corresponding 2-year rates of chronic GVHD were lower with TCD grafts than IST (19% v 50%, respectively; P < .001). There were no differences in rates of graft rejection, leukemia relapse, treatment-related mortality, and disease-free and overall survival rates. At 1 year, 54% and 12% of patients were still on immunosuppression in the IST and TCD cohorts, respectively. TCD was associated with a higher GVHD-free survival at 2 years compared with IST (41% v 19%, respectively; P = .006). Conclusion These results suggest that TCD via CD34 selection might lower long-term morbidity as a result of chronic GVHD without negatively impacting relapse rates in patients with acute myeloid leukemia. Additional prospective studies should be undertaken to definitively address the role of TCD in HCT.

scholarly journals Frequency and Outcome of Graft versus Host Disease after Stem Cell Transplantation: A Six-Year Experience from a Tertiary Care Center in Pakistan

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Natasha Ali ◽  
Salman Naseem Adil ◽  
Mohammad Usman Shaikh ◽  
Nehal Masood
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Graft Versus Host Disease ◽  
Myeloid Leukemia ◽  
Care Center ◽  
Chronic Gvhd ◽  
Tertiary Care ◽  
Host Disease ◽  
Graft Versus Host

Objective. The objective of this study was to evaluate the frequency and outcome of graft versus host disease after stem cell transplantation for various haematological disorders in Pakistan. Materials and Methods. Pretransplant workup of the patient and donor was performed. Mobilization was done with G-CSF 300 μg twice daily for five day. Standard GvHD prophylaxis was done with methotrexate 15 mg/m2 on day +1 followed by 10 mg/m2 on days +3 and +6 and cyclosporine. Grading was done according to the Glucksberg classification. Results. A total of 153 transplants were done from April 2004 to December 2011. Out of these were allogeneic transplants. There were females and males. The overall frequency of any degree of graft versus host disease was 34%. Acute GvHD was present in patients while had chronic GvHD. Grade II GvHD was present in patients while grade III and IV GvHD was seen in patients each. Acute myeloid leukemia and chronic myeloid leukemia were most commonly associated with GvHD. The mortality in acute and chronic GvHD was 8.8% and 12% respectively. Conclusion. The frequency of graft versus host disease in this study was 34% which is lower compared to international literature. The decreased incidence can be attributed to reduced diversity of histocompatibility antigens in our population.

scholarly journals Comparison of single-dose and escalating-dose regimens of donor lymphocyte infusion for relapse after allografting for chronic myeloid leukemia

Blood ◽  
2000 ◽  
Vol 95 (1) ◽  
pp. 67-71 ◽  
Author(s):  
F. Dazzi ◽  
R. M. Szydlo ◽  
C. Craddock ◽  
N. C. P. Cross ◽  
J. Kaeda ◽  
...  
Keyword(s):  
Stem Cell ◽  
Single Dose ◽  
Chronic Myeloid Leukemia ◽  
Stem Cell Transplantation ◽  
Dose Regimen ◽  
Myeloid Leukemia ◽  
Chronic Gvhd ◽  
Donor Lymphocyte Infusion ◽  
Graft Versus Host ◽  
Cytogenetic Remission

Donor lymphocyte infusion (DLI) was originally administered as a single, relatively large dose of lymphocytes called a bulk dose regimen (BDR). It has since been suggested that the use of an escalating dose regimen (EDR) may be equally effective against leukemia while it induces less graft-versus-host disease (GVHD). We therefore compared the efficacy and incidence of complications in a nonrandomized sequential study of the 2 regimens in 48 consecutive patients who had relapses with cytogenetic or hematologic evidence of chronic myeloid leukemia after allogeneic stem cell transplantation. Twenty-eight patients were treated on a BDR (August 1990 to November 1995) and 20 were treated on an EDR (December 1995 to January 1998). Although the probability of achieving cytogenetic remission within 2 years of starting DLI did not differ significantly between the 2 groups (EDR, 91% [CI, 63%–98%] vs. BDR, 67% [CI,49%–83%],P = .70), the incidence of GVHD was much lower using EDR (10% vs. 44%, P = .011). When we considered only subsets of patients treated by BDR or EDR who had received comparable total lymphoid cell doses, the incidence and severity of acute and chronic GVHD were both significantly lower for recipients treated by EDR than for recipients treated by BDR (P = .005 andP = .031, respectively). These findings suggest that the incidence of GVHD associated with the EDR is low, not because the final cell dose is small, but because lymphocytes are administered over a considerable number of months. (Blood. 2000;95:67-71)

scholarly journals Life-Threatening Hypertriglyceridemia in a Patient on Ruxolitinib and Sirolimus for Chronic Graft-versus-Host Disease

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Allison P. Watson ◽  
Claudio G. Brunstein ◽  
Shernan G. Holtan
Keyword(s):  
Graft Versus Host Disease ◽  
Myeloid Leukemia ◽  
Chronic Gvhd ◽  
Immunosuppressive Drug ◽  
Host Disease ◽  
Graft Versus Host ◽  
Jak2 Inhibitor ◽  
Life Threatening ◽  
Acute Myeloid ◽  
Steroid Refractory

Ruxolitinib is an oral selective Janus-associated kinase 1 (JAK1) and JAK2 inhibitor that was initially approved by the FDA in 2014 for treatment of myelofibrosis. In preclinical and retrospective clinical studies, use of ruxolitinib was shown to reduce graft-versus-host-disease (GVHD) in allograft recipients with moderate/severe corticosteroid-dependent or refractory chronic GVHD. While the exact mechanism for action in GVHD is not yet fully understood, prospective studies are ongoing and some patients are receiving ruxolitinib in the setting of steroid refractory GVHD. Although ruxolitinib is generally well tolerated, here we describe a case involving a 50-year-old man with acute myeloid leukemia and chronic GVHD who experienced life-threatening hypertriglyceridemia associated with concomitant use of sirolimus and ruxolitinib for GVHD. This case report highlights the importance of vigilance for severe side effects in novel immunosuppressive drug combinations.

Long-term efficacy of topical tacrolimus on oral lesions of chronic graft-versus-host disease

2007 ◽  
Vol 156 (3) ◽  
pp. 588-590 ◽  
Author(s):  
J.-C. Fricain ◽  
V. Sibaud ◽  
N. Swetyenga ◽  
R. Tabrizi ◽  
F. Campana ◽  
...  
Keyword(s):  
Graft Versus Host Disease ◽  
Oral Lesions ◽  
Host Disease ◽  
Topical Tacrolimus ◽  
Graft Versus Host ◽  
Term Efficacy

A Retrospective Review of Response to Donor Leukocyte Infusions In Adults with Acute Myeloid Leukemia After Reduced Intensity Conditioned Allogeneic Hematopoietic Cell Transplantation.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4512-4512
Author(s):  
Loretta Nastoupil ◽  
Mark A. Schroeder ◽  
Qin Zhang ◽  
Uy Geoffrey ◽  
Amanda Cashen ◽  
...  
Keyword(s):  
Overall Survival ◽  
Cell Transplantation ◽  
Myeloid Leukemia ◽  
Research Funding ◽  
Hematopoietic Cell Transplantation ◽  
Chronic Gvhd ◽  
Hematopoietic Cell ◽  
Transplant Recipients ◽  
Chi Square ◽  
Graft Versus Host

Abstract Abstract 4512 Relapse remains the most common cause of death after allogeneic hematopoietic cell transplantation (HCT), and occurs in 40% of all hematologic malignancy patients. Reduced intensity conditioning (RIC) of acute myeloid leukemia (AML) patients for HCT has been adopted as a means to reduce treatment related mortality and graft-versus-host disease (GvHD) after transplantation. The trade off of this approach has been an increased relapse risk. There is limited data on the use of donor leukocyte infusion (DLI) for AML relapse after RIC HCT. We conducted a single center retrospective review of the outcomes of DLI in adults with AML after RIC allogeneic HCT. We hypothesized that DLI given for disease relapse or graft hypoplasia would improve overall survival in patients. A database of patients undergoing hematopoietic cell transplantation (HCT) from 1997 – 2007 were screened and eligible if they had undergone a fludarabine based conditioning regimen. 33 charts were initially selected for review (16 undergoing leukocyte infusion and 17 not undergoing leukocyte infusion). 3 patients in the DLI cohort were excluded because they had undergone a second transplant and 11 patients in the non-DLI cohort were excluded for no evidence of relapse. A cohort of 13 DLI patients and 6 non-DLI controls were included in the analysis. The median age of patients undergoing DLI was 52 (69% males). 8% of recipients had evidence of graft-versus-host disease (GvHD) prior to DLI and 61% were reported to have GvHD after DLI. 46% of transplant recipients had evidence of disease at the time of RIC HCT. 92% of DLI recipients received DLI for disease relapse and all underwent treatment with either chemotherapy or radiation prior to DLI. Those patients receiving DLI had prolonged survival compared to the non-DLI cohort (Wilcoxon chi-square = 4.212, p=0.04). Variables that statistically predicted overall survival in the DLI treated cohort were disease after DLI (Log rank chi-square = 12.636, p=0.002), chronic GvHD after DLI (Log Rank chi-sqare = 3.932, p=0.047), undergoing a HLA matched transplant (Log rank chi-square 5.017, p=0.025) and CMV positive recipient (Log rank chi-square = 4.562, p=0.033). Other variables that were not significant in predicting survival after DLI included: acute or chronic GvHD before DLI, disease specific treatment before DLI, gender, cytokines at the time of transplant or DLI, total number of DLI's, recipient lymphocyte count pre-DLI, immunosuppression at the time of DLI, CD3 dose, leukemic burden measured by blast percentage on bone marrow biopsy pre-DLI, and cytogenetic risk group. We conclude that DLI improves survival for relapsed AML patients after RIC HCT. The risk for GvHD is significant but no patients experienced life threatening GvHD in this cohort. Interestingly, complete HLA matched transplant recipients had improved survival after DLI over mismatched transplant recipients undergoing DLI. Limited by the small sample size, we did not have enough power to conduct multiple regression analysis. In the future we plan to model predictors of overall survival, progression free survival and GvHD after DLI in a larger cohort including myeloablative conditioning in adult patients with AML. Disclosures: Schroeder: Genzyme: Research Funding; Celgene: Research Funding; NIH/NHLBI 5K12HL08710703: Research Funding. Westervelt:Novartis: Honoraria; Celgene: Honoraria, Speakers Bureau. DiPersio:Genzyme: Honoraria. Vij:Novartis: Honoraria; Eisai: Speakers Bureau.

HLA DR15 Antigen Status Does Not Impact Graft-Versus-Host Disease or Disease-Free Survival in HLA-Matched Sibling Transplantation for Hematologic Malignancies

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3094-3094
Author(s):  
Minoo Battiwalla ◽  
Kristin Ellis ◽  
Steven Z. Pavletic ◽  
Gorgun Akpek ◽  
Peiman Hematti ◽  
...  
Keyword(s):  
Overall Survival ◽  
Myeloid Leukemia ◽  
Acute Gvhd ◽  
Chronic Gvhd ◽  
Univariate Analysis ◽  
Disease Free Survival ◽  
Free Survival ◽  
Graft Versus Host ◽  
Matched Sibling ◽  
Disease Free

Abstract Abstract 3094 The HLA class II DRB1 antigen DR15 is an important immunobiologic marker in immune mediated marrow failure states. DR15 has also been reported in small studies to be associated with favorable outcomes (reduction in acute GVHD and reduced relapse resulting in improved overall survival) after allogeneic hematopoietic cell transplant. To elucidate the impact of DR15 on major transplant outcomes, we conducted a retrospective study of 2, 891 recipients of first marrow or mobilized peripheral blood stem cell transplantation for the treatment of acute myeloid leukemia (n=1038), acute lymphoblastic leukemia (n=700), chronic myeloid leukemia (n=948), or myelodysplastic syndrome (n=205) between 1990–2008 and reported to the CIBMTR registry. Selection was confined to HLA-identical sibling transplantation to avoid HLA-disparity as a driving force for observed differences. All patients received conventional myeloablative conditioning, T-replete grafts and cyclosporine plus methotrexate- based GVHD prophylaxis. DNA-based HLA typing allowed categorization of 732 (25.3%) patients as positive and 2159 (74.7%) patients as negative for DRB1*15 :01 or *15 :02 (DR15). There were no significant differences in baseline characteristics between the HLA DR15-positive and -negative groups. In univariate analysis, HLA-DR15 status had no impact on neutrophil engraftment, acute graft-versus-host disease (GvHD) II-IV or III-IV, chronic GVHD, treatment related mortality, relapse, disease-free survival or overall survival. Confining the univariate analysis to myeloid malignancies did not alter these findings. Multivariate analysis models were constructed with DR15 status forced into the models in all steps of model building and the final model regardless of its statistical significance. Other variables tested included: donor/recipient age, CMV status, disease, disease stage, graft source, Karnofsky score, race and year of transplant. Variables that attained a p-value ≤0.05 were held in the final multivariate models. In multivariate analysis, DR15 status showed no significant difference in the primary outcomes of acute GVHD II-IV or III-IV, chronic GVHD, overall survival, or relapse. In conclusion, DR15 status had no impact on major HLA-matched sibling donor hematopoietic cell transplantation outcomes in this large and homogenous cohort of leukemia and MDS patients. Disclosures: No relevant conflicts of interest to declare.

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