HLA Today


HLA Today

Booth 2100 at ASH 2019

Improve Outcomes for AML with HLA Today

HLA Today is a free program for patients with acute myeloid leukemia (AML) that aims to improve patient outcomes by providing physicians with critical information as early as possible in a patient’s disease course. Through the HLA Today initiative, the National Marrow Donor Program® (NMDP)/Be The Match® is providing high resolution human leukocyte antigen (HLA) typing and a preliminary donor search report for patients newly diagnosed with AML at no charge to providers or patients.

Request HLA Today Kits

How HLA Today Works

The NMDP/Be The Match will provide a sample kit with all that is needed to get the following HLA Today process started.

At the time of AML diagnosis, genetic material is gently collected from the patient’s cheek using a buccal swab kit provided by the NMDP/Be The Match.

The patient’s completed kit is sent to NMDP/Be The Match for HLA typing.

After 7-10 days, high resolution HLA typing and a report on unrelated donor matches from the Be The Match Registry® is sent to the patient’s physician at no cost to the provider or patient.

Why HLA Today?

Allogeneic hematopoietic cell transplantation (HCT) may be the only chance for a cure for many patients with AML. HLA Typing at diagnosis, along with molecular marker and cytogenetics testing results, are key to understanding all options and planning the best treatment course for patients with AML. HCT in early stage disease has been shown to significantly improve survival for patients with AML who have intermediate-or poor-risk cytogenetics. [2] Initiating the process to find an unrelated donor for HCT soon after a patient’s diagnosis can increase the likelihood that the patient can undergo transplant at the optimal time. More information on disease risk stratification and referral timing guidelines for AML can be found in the drop-down’s below.

Disease Risk Stratification

Evolving research is altering how cytogenetic and molecular markers are used to guide therapeutic choices in AML. Table 1 shows risk status based on validated cytogenetics and molecular markers from the NCCN Clinical Practice Guidelines In Oncology (NCCN Guidelines®) for Acute Myeloid Leukemia.

Table 1. European LeukemiaNet Risk Stratification By Genetics in Non-APL AML

 Risk Category  Genetic Abnormality
 FAVORABLE  t(8;21)(q22;q22.1); RUNX1-RUNX1T1  
 inv(16)(p13.1q22) or t(16;16)(p13.1;q22); CBFB-MYH11
 Mutated NPM1 without FLT3-ITD or with FLT3-ITDlow

 Biallelic mutated CEBPA 
 INTERMEDIATE Mutated NPM1 and FLT3-ITDhigh
Wild-type NPM1 without FLT3-ITD or with FLT3-ITDlow (without adverse-risk genetic lesions)
 t(9;11)(p21.3;q23.3); MLLT3-KMT2A
 Cytogenetic abnormalities not classified as favorable or adverse 
 POOR/ADVERSE  t(6;9)(p23;q34.1); DEK-NUP214 
 t(v;11q23.3); KMT2A rearranged
 t(9;22)(q34.1;q11.2)BCR-ABL1
 inv(3)(q21.3q26.2) or t(3;3)(q21.3;q26.2); GATA2, MECOM(EVI1)
 -5 or del(5q); -7;-17/abn(17p)
 Complex karyotype, monosomal karyotype
 Wild-type NPM1 and FLT3-ITDhigh
 Mutated RUNX1
 Mutated ASXL1
 Mutated TP53

Adapted with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Acute Myeloid Leukemia V.1.2019, 01/18/19 © 2019 National Comprehensive Cancer Network, Inc. All rights reserved. The NCCN Guidelines® and illustrations herein may not be reproduced in any form for any purpose without the express written permission of the NCCN. To view the most recent and complete version of the NCCN Guidelines, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.

For patients with intermediate- and poor-risk cytogenetics, a meta-analysis demonstrated a survival benefit of allogeneic HCT in first complete remission over chemotherapy. [1] Early referral for HCT evaluation for these at-risk patients at an early disease stage can significantly improve survival. [3,4]

The National Marrow Donor Program® (NMDP)/Be The Match® and the American Society for Blood and Marrow Transplantation (ASBMT) have jointly developed guidelines for transplant referral timing based on disease characteristics (see " Referral Timing Guidelines" section below).

 

Referral Timing Guidelines

These guidelines identify appropriate timing of consultation for transplant based on disease characteristics. [5]

Transplant Consultation Guidelines: Adult AML

High-resolution HLA typing is recommended at diagnosis for all patients

Early after initial diagnosis, all patients with AML including:

  • Primary induction failure
  • Minimal residual disease after initial therapy
  • CR1 - except favorable risk AML [defined as: t(16;16), inv 16, or t(8;21) without c-KIT mutation; t(15;17); normal cytogenetics with NPM1 or isolated biallelic CEBPA mutation and without FLT3-ITD]
  • Antecedent hematological disease (e.g., myelodysplastic syndrome (MDS))
  • Treatment-related leukemia
  • First relapse
  • CR2 and beyond, if not previously evaluated
Download slide (PPT)
View complete Referral Timing Guidelines

Randomized, controlled clinical data demonstrates the clinical benefit of early HLA typing. In a study of over 700 adult patients with AML (SWOG 1203), HLA typing was expedited for all patients with poor-risk cytogenetics at the time of diagnosis. The following compelling results were seen:

  • 64% transplant rate in first complete remission (CR1) compared to the historical rate of 40%. (p <0.001)
  • 45% increase in two-year relapse-free survival (32% vs 22% historical rate, p=0.05)

Researchers concluded that better outcomes in poor prognosis patients with AML may be achieved by initiating the process to find donors at the time of diagnosis and performing HCT consistently in CR1. [2]

Get Started with HLA Today

To request HLA Today swab kits or to receive more information about the program, fill out the form below. You can also contact us directly at HLAToday@nmdp.org. 

References

  1. Koreth J, Schlenk R, Kopecky KJ, et al. Allogeneic stem cell transplantation for acute myeloid leukemia in first complete remission: Systematic review and meta-analysis of prospective clinical trials. JAMA. 2009; 301(22): 2349-2361.Access
  2. Pagel JM, Othus M, Garcia-Manero G, et al. Feasibility of allogeneic hematopoietic cell transplantation among high-risk AML patients in first complete remission: Results of the transplant objective from the SWOG (S1203) randomized phase III study of induction therapy using standard 7+3 therapy or idarubicin with high-dose cytarabine (IA) versus IA plus vorinostat. Blood. 2016; 128(22): 1166. Access
  3. Pidala J, Lee SJ, Ahn KW, et al. Nonpermissive HLA-DPB1 mismatch increases mortality after myeloablative unrelated allogeneic hematopoietic cell transplantation. Blood. 2014; 124(16): 2596-2606. Access Access
  4. Lee SJ, Klein J, Haagenson M, et al. High-resolution donor-recipient HLA matching contributes to the success of unrelated donor marrow transplantation. Blood. 2007; 110(13): 4576-4583. Access Access
  5. NMDP/Be The Match and ASBMT Recommended Timing for Transplant Consultation. Download (PDF) Access