Impact of HLA class I high-resolution mismatches on chronic graft-versus-host disease and survival of patients given hematopoietic stem cell grafts from unrelated donors.
There is consensus that matching of unrelated donors (URD) and patients for HLA class II alleles improves the outcome of hematopoietic stem cell transplantation (HSCT). However, the significance of HLA class I allelic mismatches for transplant outcome is under discussion and reports on long-term effects like chronic graft-versus-host disease (GVHD) are rare. Thus, we investigated the association of human leukocyte antigen (HLA) class I allele mismatches and outcome in 144 patients given HSCT from URD who were matched for HLA-DRB1, DRB3/4/5, and DQB1 alleles. The risk of chronic GVHD was significantly increased in patients with class I mismatched donors, the mismatch either detected by low- or high-resolution typing. A single HLA class I allele mismatch significantly increased the risk of chronic GVHD in multivariate analysis. Overall survival was significantly reduced in patient/donor pairs with more than one-allele class I mismatch. Thus, selection of unrelated donors for transplantation should be based on high-resolution HLA class I typing.
Greinix
H T
HT
Department of Medicine I, Bone Marrow Transplantation, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. hildegard.greinix@meduniwien.ac.at
Faé
I
I
Schneider
B
B
Rosenmayr
A
A
Mitterschiffthaler
A
A
Pelzmann
B
B
Kalhs
P
P
Lechner
K
K
Mayr
W R
WR
Fischer
G F
GF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000483:Alleles; D001782:Blood Donors; D001787:Blood Group Incompatibility; D005260:Female; D005805:Genes, MHC Class I; D005802:Genes, MHC Class II; D006085:Graft Survival; D006086:Graft vs Host Disease; D006680:HLA Antigens / Q000096:biosynthesis*; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006412:Hematopoietic Stem Cells / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D006680:HLA Antigens