Allogeneic marrow transplantation: the Seattle experience.
Allogeneic marrow transplantation from a normal donor provides potential life-saving therapy for a variety of inherited and acquired diseases of the hematopoietic and immune systems including malignancies. However, even with an HLA-identical sibling donor the success of allografts can be compromised by GvHD and associated complications such as opportunistic infection. Non-HLA minor histocompatibility determinants still represent significant barriers to safe and successful transplants in some cases. In the absence of an HLA-identical sibling, alternate donors, including HLA-matched unrelated volunteers and HLA partially matched relatives can provide opportunity for effective therapy, though with increased risk of graft rejection and GvHD. HLA matching appears to be a critical factor, with the incidence and severity of GvHD exceeding acceptable limits as the number of incompatible HLA antigens increases. Although the United States NMDP and the marrow donor registries in other countries that currently have more than 1.2 million HLA-typed donors have profoundly improved the likelihood of finding an HLA-matched unrelated donor for the majority of White patients, many Whites and most patients of other racial origin cannot at this time find a match. Effective and safe treatment for these patients will require improved methods for managing HLA-mismatched transplants.
Hansen
J A
JA
Fred Hutchinson Cancer Research Center, Department of Medicine, University of Washington, Seattle.
Anasetti
C
C
Martin
P J
PJ
Mickelson
E M
EM
Petersdorf
E
E
Thomas
E D
ED
D000046:Academic Medical Centers; D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000706:statistics & numerical data; D006086:Graft vs Host Disease / Q000517:prevention & control; D006680:HLA Antigens / Q000032:analysis; D006239:Haplotypes; D006402:Hematologic Diseases / Q000276:immunology / Q000401:mortality / Q000628:therapy; D006650:Histocompatibility Testing; D006801:Humans; D007108:Immune Tolerance; D007959:Lymphocyte Culture Test, Mixed; D008875:Middle Aged; D015996:Survival Rate; D014019:Tissue Donors; D014184:Transplantation, Homologous; D014861:Washington / Q000453:epidemiology
D006680:HLA Antigens