Objective: To compare the clinical characteristics and prognosis of acute graft-versus-host disease (aGVHD) between patients undergoing human leukocyte antigen (HLA)-identical and HLA-mismatched allogeneic hematopoietic stem cell transplantation (allo-HSCT).
Methods: Clinical data of 544 patients receiving related allo-HSCT in Institute of Hematology of Peking University from January 2010 to December 2011 were retrospectively analyzed. The clinical features of aGVHD including manifestations and prognosis between HLA-identical and HLA-mismatched transplantation were compared.
Results: The cumulative incidence of aGVHD in related HLA-mismatched transplant was 50.2%, which was significantly higher than that of HLA-identical transplant (20.4%, P < 0.001). However, the cumulative incidence of grade III°-IV° aGVHD between the two groups was comparable (4.5% vs 6.8%, P = 0.066). Gut aGVHD accounted for 31.1% in HLA-identical transplant while cutaneous aGVHD was the dominant area in HLA-mismatched transplant (66.5%). The incidence of gut and liver aGVHD in HLA-mismatched patients was also lower than that in HLA-identical patients. The proportion of patients with aGVHD accompanied by fever was higher in HLA-mismatched patients than in HLA-identical patients (47.6% vs 28.9%, P = 0.028). The cure rate of aGVHD in identical transplant was lower than that in mismatched transplant, especially for grade III°-IV° aGVHD. The complete remission rate after second-line anti-GVHD therapies was lower than that of mismatched transplant (88.9% vs 98.8%, P = 0.006). More patients died of aGVHD in identical transplant compared with mismatched transplant (11.1% vs 2.4%, P = 0.024).
Conclusion: More patients who received HLA-mismatched allo-HSCT develop into aGVHD compared with HLA-identical transplant. But the incidence of severe aGVHD between HLA-identical and -mismatched is comparable. The overall cure rate of HLA-mismatched transplant is significantly higher than that of HLA-identical transplant.