title: The importance of HLA-DPB1 in unrelated donor hematopoietic cell transplantation.
abstract: Hematopoietic cell transplantation (HCT) from an HLA-A, HLA-B, HLA-C, HLA-DRB1, and HLA-DQB1 allele-matched unrelated donor is a well-recognized life-saving treatment modality for patients with hematologic disorders. The morbidity and mortality from clinically significant acute graft-versus-host disease (aGVHD) remains a limitation. The extent to which transplantation outcome may be improved with donor matching for HLA-DP is not well defined. The risks of aGVHD, relapse, and mortality associated with HLA-DPB1 allele mismatching were determined in 5929 patients who received a myeloablative HCT from an HLA-A-, HLA-B-, HLA-C-, HLA-DRB1-, and HLA-DQB1-matched or -mismatched donor. There was a statistically significantly higher risk of both grades 2 to 4 aGVHD (odds ratio [OR] = 1.33; P < .001) and grades 3 to 4 aGVHD (OR = 1.26; P < .001) after HCT from an HLA-DPB1-mismatched donor compared with a matched donor. The increased risk of aGVHD was accompanied by a statistically significantly decrease in disease relapse (hazard ratio [HR] = 0.82; P = .01). HLA-DPB1 functions as a classical transplantation antigen. The increased risk of GVHD associated with HLA-DPB1 mismatching is accompanied by a lower risk of relapse. Knowledge of the DPB1 matching status prior to transplantation will aid in more precise risk stratification for the individual patient.
authors.affiliation: Anthony Nolan Research Institute, London, UK. bshaw@doctors.org.uk
authors.forename: Bronwen E
authors.initials: BE
authors.lastname: Shaw
authors.forename: Theodore A
authors.initials: TA
authors.lastname: Gooley
authors.forename: Mari
authors.initials: M
authors.lastname: Malkki
authors.forename: J Alejandro
authors.initials: JA
authors.lastname: Madrigal
authors.forename: Ann B
authors.initials: AB
authors.lastname: Begovich
authors.forename: Mary M
authors.initials: MM
authors.lastname: Horowitz
authors.forename: Alois
authors.initials: A
authors.lastname: Gratwohl
authors.forename: Olle
authors.initials: O
authors.lastname: Ringdén
authors.forename: Steven G E
authors.initials: SG
authors.lastname: Marsh
authors.forename: Effie W
authors.initials: EW
authors.lastname: Petersdorf
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000483:Alleles; D002648:Child; D002675:Child, Preschool; D015991:Epidemiologic Measurements; D005260:Female; D006086:Graft vs Host Disease / Q000276:immunology; D006682:HLA-DP Antigens / Q000276:immunology*; D059868:HLA-DP beta-Chains; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006648:Histocompatibility / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012008:Recurrence; D012306:Risk; D015996:Survival Rate; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D006682:HLA-DP Antigens; D059868:HLA-DP beta-Chains; C071170:HLA-DPB1 antigen