title: Acceptable HLA-mismatching in unrelated donor bone marrow transplantation for patients with acquired severe aplastic anemia.
abstract: We retrospectively analyzed the effect of HLA mismatching (HLA-A, -B, -C, -DRB1, -DQB1) with molecular typing on transplantation outcome for 301 patients with acquired severe aplastic anemia (SAA) who received an unrelated BM transplant through the Japan Marrow Donor Program. Additional effect of HLA-DPB1 mismatching was analyzed for 10 of 10 or 9 of 10 HLA allele-matched pairs (n = 169). Of the 301 recipient/donor pairs, 101 (33.6%) were completely matched at 10 of 10 alleles, 69 (23%) were mismatched at 1 allele, and 131 (43.5%) were mismatched at ≥ 2 alleles. Subjects were classified into 5 subgroups: complete match group (group I); single-allele mismatch group (groups II and III); multiple alleles restricted to HLA-C, -DRB1, and -DQB1 mismatch group (group IV); and others (group V). Multivariate analysis indicated that only HLA disparity of group V was a significant risk factor for poor survival and grade II-IV acute GVHD. HLA-DPB1 mismatching was not associated with any clinical outcome. We recommend the use of an HLA 10 of 10 allele-matched unrelated donor. However, if such a donor is not available, any single-allele or multiple-allele (HLA-C, -DRB1, -DQB1) mismatched donor is acceptable as an unrelated donor for patients with severe aplastic anemia.
authors.affiliation: Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yagasaki
authors.forename: Seiji
authors.initials: S
authors.lastname: Kojima
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Yabe
authors.forename: Koji
authors.initials: K
authors.lastname: Kato
authors.forename: Hisato
authors.initials: H
authors.lastname: Kigasawa
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sakamaki
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tsuchida
authors.forename: Shunichi
authors.initials: S
authors.lastname: Kato
authors.forename: Takakazu
authors.initials: T
authors.lastname: Kawase
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Morishima
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kodera
mesh_terms: D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D016026:Bone Marrow Transplantation / Q000276:immunology* / Q000401:mortality / Q000592:standards; D002648:Child; D002675:Child, Preschool; D005260:Female; D006680:HLA Antigens / Q000276:immunology*; D059868:HLA-DP beta-Chains / Q000235:genetics / Q000276:immunology; D006650:Histocompatibility Testing / Q000592:standards; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D058889:Molecular Typing; D012720:Severity of Illness Index; D012801:Sibling Relations; D014019:Tissue Donors; D055815:Young Adult
chemical_list: D006680:HLA Antigens; D059868:HLA-DP beta-Chains; C071170:HLA-DPB1 antigen