High resolution HLA matching associated with decreased mortality after unrelated bone marrow transplantation

Details

Serval ID
serval:BIB_B7F6B55FFAC5
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
High resolution HLA matching associated with decreased mortality after unrelated bone marrow transplantation
Journal
Blood
Author(s)
Speiser  D. E., Tiercy  J. M., Rufer  N., Grundschober  C., Gratwohl  A., Chapuis  B., Helg  C., Loliger  C. C., Siren  M. K., Roosnek  E., Jeannet  M.
ISSN
0006-4971 (Print)
Publication state
Published
Issued date
05/1996
Volume
87
Number
10
Pages
4455-62
Notes
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't --- Old month value: May 15
Abstract
As compared with related HLA-identical sibling donors, bone marrow transplantation (BMT) with phenotypically HLA ABDR-compatible unrelated donors is associated with increased mortality. This may be due to hidden HLA incompatibilities not detected by conventional typing. We have analyzed 44 unrelated patient-donor pairs who were matched for HLA-A, -B, and -DR by routine tissue typing. Our comprehensive HLA typing approach consisted of serology, cytotoxic T-cell precursor (CTLp) tests, T-cell cloning, oligotyping, and DNA sequencing. Using these techniques, we identified numerous HLA allele mismatches not detected by the previously applied routine typing. Twenty-four patient-donor pairs were highly matched and had a low CTLp frequency, whereas the remaining 20 pairs were allele-mismatched for HLA-A, -B, -C, -DR, -DQ antigens and/or had a positive result of the CTLp test. Patient and donor age, diagnosis, and treatment did not differ significantly between the matched and mismatched transplants. The probability for severe acute graft-versus-host disease grades III-IV was 21% in the matched and 47% in the mismatched patients (P = .0464). Transplant-related mortality was 21% and 57% (P = .0072) and actuarial patient survival rates at 3 years were 61% and 13% (P = .0005). We conclude that both HLA class I and class II allele mismatches between unrelated phenotypically ABDR-compatible patient-donor pairs are frequent and associated with increased incidence of posttransplant complications.
Keywords
Alleles Bone Marrow Transplantation/immunology/*mortality Cause of Death Female Follow-Up Studies Graft vs Host Disease/immunology/mortality/prevention & control HLA Antigens/analysis/immunology Histocompatibility Testing/*methods Humans Infection/etiology/mortality Life Tables Male Survival Analysis Survival Rate Transplantation, Homologous/immunology/mortality
Pubmed
Web of science
Create date
28/01/2008 11:33
Last modification date
20/08/2019 15:26
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