Mark R. Litzow 2, Dennis A. Gastineau 2, William J. Hogan 2,. Justin D. Kreuter 1, ... Clinic, Rochester, MN; 2 Division of Hematology, Mayo Clinic,. Rochester, MN; 3 ... matched for HLA-A, B, C, DRB1 and DQB1 loci (10/10) at the allele level ...
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Abstracts / Biol Blood Marrow Transplant 22 (2016) S19eS481
cytomegalovirus antibody positivity (HR, 1.4; 95% CI, 1.1e1.9; P ¼ 0.02) were significantly associated with increased risk in GRFS. Conclusion: GRFS was a novel composite end point. Disease risk, RPB, and cytomegalovirus antibody positivity may be adverse factors for GRFS in Japanese patients.
504 Clinical Outcomes of HLA-DPB1 Mismatches in 10/10 HLAMatched Unrelated Donor-Recipient Pairs Undergoing Allogeneic Stem Cell Transplant Ann M. Moyer 1, Shahrukh K. Hashmi 2, Cynthia M. Kroning1, Walter K. Kremers 3, Steven R. De Goey1, Mrinal S. Patnaik 4, Mark R. Litzow 2, Dennis A. Gastineau 2, William J. Hogan 2, Justin D. Kreuter 1, Laurie L. Wakefield1, Manish Gandhi 1. 1 Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN; 2 Division of Hematology, Mayo Clinic, Rochester, MN; 3 Department of Health Sciences Research, Mayo Clinic, Rochester, MN; 4 Division of Hematology, Mayo Clinic Rochester, Rochester, MN Background: Matching for HLA-DPB1 lowers relapse risk in allogeneic hematopoietic stem cell transplantation (ASCT), but this locus is not in linkage disequilibrium with the remainder of the HLA genes, making matching more difficult. Recent studies have suggested that after classifying HLADPB1 mismatches based on T-cell epitope group, avoiding non-permissive mismatches leads to improved survival. We tested this hypothesis in our patient population. Methods: We conducted a retrospective analysis of 158 patients who underwent ASCT at the Mayo Clinic 1/1/2008 -5/ 25/2013. Patients with unrelated volunteer donors were matched for HLA-A, B, C, DRB1 and DQB1 loci (10/10) at the allele level without consideration of the HLA-DPB1 locus. Patient and donor HLA-DPB1 genotyping was performed by reverse SSO typing and the ImMunoGeneTics/HLA (IMGT/ HLA) T-cell epitope matching algorithm version 2.0 was used to determine mismatch status as permissive or nonpermissive. Association between HLA-DPB1 matching status and clinical outcomes was studied using univariate and multivariate proportional hazards models. In multivariate analyses, outcomes were adjusted for covariates associated with outcome as determined by stepwise backward elimination approach. Results: Of 158 donor recipient pairs, there were 21 HLADPB1 matches, 70 permissive mismatches, and 67 nonpermissive mismatches (26 in the graft-vs-host [GvH] direction, 41 in the host-vs-graft [HvG] direction). In a univariate analysis, when matches and permissive mismatches were combined into a group and compared to non-permissive mismatch, there was no significant difference in overall survival (p¼0.10), relapse (p¼0.71), neutrophil or platelet engraftment (p¼0.78 and p¼0.70, respectively). Acute graftvs-host disease (aGVHD) and grade III-IV aGVHD was more frequent among patients with non-permissive mismatches in the GvH direction (p¼0.037 and 0.045, respectively). No significant difference was observed in chronic GVHD (cGVHD) among the permissive and non-permissive groups (p¼0.99). In multivariate analysis, no differences in survival were observed between the permissive and non-permissive groups (p¼0.08). Conclusions: We identified an increased risk of aGVHD and grade III-IV aGVHD among patients receiving non-permissive DPB1 mismatches in the GvH direction. No significant differences in survival, relapse, engraftment, or chronic GVHD were observed among the patients with HLA-DPB1 donor matches, permissive mismatches, and non-permissive
mismatches. Further work from large databases is necessary to fully understand the impact on clinical outcomes of HLADPB1 mismatches in other populations.
505 Burden of Cytomegalovirus Infection Among Allogeneic Hematopoietic Cell Transplant Recipients Essy Mozaffari1, Jay Lin2, Melissa Lingohr-Smith3. 1 Chimerix Inc, Durham, NC; 2 Health Economics & Outcomes Research, Novosys Health, Green Brook, NJ; 3 Novosys Health, Green Brook, NJ Purpose: Cytomegalovirus (CMV) infection in allogeneic hematopoietic cell transplant (allo-HCT) recipients is associated with numerous complications, as well as increased non-relapse mortality. The objectives of this study were to examine the frequency of CMV infection during hospitalization for allo-HCT and the impact of CMV infection on length of stay (LOS) in hospital, mortality during the index hospitalization, frequency of hospital readmission, and 1year mortality. Methods: Patients who underwent allo-HCT between January 2009 and September 2013 were identified based on ICD-9 diagnosis codes obtained from the hospital discharge records of the Premier Hospital database. Hospitalization with allo-HCT was defined as the index hospitalization. Demographics, clinical characteristics, and LOS for the index hospitalization were evaluated for patients with and without CMV infection during the index hospitalization. Mortality during index hospitalization was evaluated, as were hospital readmission frequency and readmission mortality during the first year following allo-HCT. Results: Among the study population of allo-HCT recipients (N¼1617; mean age 42.5 years), 57% were male and 82% were 18 years. Based on the ICD-9 codes recorded for the index hospitalization, 7% (n¼110) of the study population had CMV infection. Furthermore, hospital LOS for the index HCT hospitalization was significantly greater for those with CMV infection than for those without (59 vs 33 days; p
