Optimizing outcome after unrelated marrow transplantation by comprehensive matching of HLA class I and II alleles in the donor and recipient.
In unrelated marrow transplantation, the benefit of matching class II HLA-DRB1 and DQB1 alleles of the donor and recipient is well documented. Little is known about the clinical relevance of matching for class I HLA-A, B, and C alleles. We used DNA-amplification methods to identify the HLA-A, B, and C alleles of 300 patients and their donors. The incidence of graft failure was correlated with multiple class I mismatching in the donor. The risk of grades III-IV acute graft-versus-host disease was highest with class II mismatching in the recipient. Mismatching for a single class I or class II allele had no effect on survival, but mortality was increased by mismatching for more than one class I allele and by simultaneous mismatching for class I and class II alleles. We conclude that matching HLA class I and class II alleles of the donor and recipient can improve outcome after unrelated marrow transplantation.
Petersdorf
E W
EW
Division of Clinical Research, Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine, Seattle, WA, USA.
Gooley
T A
TA
Anasetti
C
C
Martin
P J
PJ
Smith
A G
AG
Mickelson
E M
EM
Woolfrey
A E
AE
Hansen
J A
JA
D000483:Alleles; D016026:Bone Marrow Transplantation / Q000276:immunology* / Q000401:mortality; D004247:DNA / Q000235:genetics; D006084:Graft Rejection / Q000276:immunology; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000276:immunology; D006680:HLA Antigens / Q000235:genetics / Q000276:immunology*; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D015993:Life Tables; D012189:Retrospective Studies; D012306:Risk; D017422:Sequence Analysis, DNA; D012703:Serotyping; D016019:Survival Analysis; D014019:Tissue Donors; D014184:Transplantation, Homologous / Q000276:immunology* / Q000401:mortality; D016896:Treatment Outcome
D006680:HLA Antigens; D004247:DNA