Patients with acute myeloid leukaemia (AML) who lack a matched sibling or unrelated donor commonly undergo transplantation from a donor matched at 9/10 HLA-A, -B, -C, -DRB1, -DQB1 alleles, and it is unclear if a specific locus mismatch is preferable to any other. We therefore studied 937 patients with AML in complete remission transplanted using a reduced intensity conditioning regimen from an unrelated donor mismatched at a single allele. In a multivariate analysis, patient age, adverse karyotype and patient cytomegalovirus (CMV) seropositivity were correlated with decreased leukaemia free survival (LFS) and overall survival (OS). There was no significant difference in LFS or OS between patients transplanted from donors mismatched at HLA-A, -B, -C or -DRB1 in comparison to a HLA-DQB1 mismatched transplant. In a multivariate analysis, patients transplanted with a HLA-A mismatched donor had higher rates of acute graft-versus-host disease (GVHD) and non-relapse mortality (NRM) than patients transplanted with a HLA-DQB1 mismatched donor. Patient CMV seropositivity was associated with an increase in NRM and acute GVHD and reduced LFS and OS, regardless of donor CMV status. For CMV seropositive patients lacking a fully matched donor, alternative GVHD and CMV prophylaxis strategies should be considered.

Centre for Clinical Haematology Queen Elizabeth Hospital Birmingham UK

Department of Haematology Hemostasis Oncology and Stem Cell Transplantation Hannover Medical School Carl Neuberg Str 1 Hannover Germany

Department of Haematology Oncology Charles University Hospital Alej Svobody 80 304 60 Pilsen Czech Republic

Department of Hematology Acute Leukemia and Transplantation Unit UZ Leuven Herestraat 49 B 3000 Leuven Belgium

Department of Hematology and Cell Therapy Hospital Saint Antoine Paris France

Department of Hematology Karolinska University Hospital Huddinge Stockholm Sweden

Division of Stem Cell Transplantation and Immunotherapy University of Kiel Kiel Germany

Erasmus Medical Center Daniel den Hoed Cancer Center Rotterdam The Netherlands

Hematology Division Chaim Sheba Medical Center Tel Hashomer Ramat Gan Israel

Paris EBMT Data Coordination Office Hospital Saint Antoine APHP Université Pierre et Marie Curie UPMC and INSERM U 938 Paris France

State Medical Pavlov University St Petersburg Russia

Transplant and Cellular Therapy Unit Institut Paoli Calmettes Marseille France

University of Leipzig Leipzig Germany

Vanderbilt University Medical Center Nashville TN USA

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