title: Evaluation of HLA matching in unrelated hematopoietic stem cell transplantation for nonmalignant disorders.
abstract: The importance of human leukocyte antigen (HLA) matching in unrelated donor transplantation for nonmalignant diseases (NMD) has yet to be defined. We analyzed data from 663 unrelated marrow and peripheral blood stem cell transplants performed from 1995 to 2007 for treatment of NMD. Transplantation from a donor mismatched at the HLA-A, -B, -C, or -DRB1, but not -DQB1 or -DPB1, loci was associated with higher mortality in multivariate analyses (P = .002). The hazard ratio for mortality for single (7/8) and double mismatched (6/8) transplants was 1.29 (0.97-1.72; P = .079) and 1.82 (1.30-2.55; P = .0004), respectively, compared with 8/8 matched transplants. HLA mismatches were not associated with acute or chronic GVHD, but were strongly associated with graft failure. After adjustment for other factors, the odds ratio for graft failure for 7/8 and 6/8 (allele and/or antigen) matched pairs compared with 8/8 matched transplants was 2.81 (1.74-4.54; P < .0001) and 2.22 (1.26-3.97; P = .006), respectively. Patients with NMD should receive transplants from allele matched (8/8) donors if possible. Unlike the case with malignancies, HLA mismatching in NMD is associated with graft failure rather than GVHD.
authors: Emory University, Atlanta, GA 30322, USA. john.horan@choa.org
authors: John
authors: J
authors: Horan
authors: Tao
authors: T
authors: Wang
authors: Michael
authors: M
authors: Haagenson
authors: Stephen R
authors: SR
authors: Spellman
authors: Jason
authors: J
authors: Dehn
authors: Mary
authors: M
authors: Eapen
authors: Haydar
authors: H
authors: Frangoul
authors: Vikas
authors: V
authors: Gupta
authors: Gregory A
authors: GA
authors: Hale
authors: Carolyn K
authors: CK
authors: Hurley
authors: Susana
authors: S
authors: Marino
authors: Machteld
authors: M
authors: Oudshoorn
authors: Vijay
authors: V
authors: Reddy
authors: Peter
authors: P
authors: Shaw
authors: Stephanie J
authors: SJ
authors: Lee
authors: Ann
authors: A
authors: Woolfrey
mesh_terms: D000293:Adolescent; D000328:Adult; D001782:Blood Donors; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000276:immunology*; D006086:Graft vs Host Disease / Q000209:etiology* / Q000401:mortality*; D006680:HLA Antigens / Q000276:immunology*; D006402:Hematologic Diseases / Q000150:complications* / Q000628:therapy; D006648:Histocompatibility / Q000276:immunology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D015996:Survival Rate; D061349:Unrelated Donors; D055815:Young Adult
chemical_list: D006680:HLA Antigens