HLA match likelihoods for hematopoietic stem-cell grafts in the U.S. registry.
HLA match likelihoods for hematopoietic stem-cell grafts in the U.S. registry.
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DOI：
10.1056/nejmsa1311707
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发表时间：
2014-07-24
期刊：
影响因子：
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通讯作者：
Maiers M
中科院分区：
文献类型：
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作者：
Gragert L;Eapen M;Williams E;Freeman J;Spellman S;Baitty R;Hartzman R;Rizzo JD;Horowitz M;Confer D;Maiers M
造血干细胞移植（HSCT）是一种潜在的挽救生命的治疗几种血癌和其他疾病。对于没有合适的相关HLA匹配供体的患者，成人志愿者和库存脐带血单位的无关供体登记处，如国家骨髓供体计划（NMDP）运营的Be the Match Registry，提供了潜在的供体来源。我们在本研究中的目标是衡量在美国注册中找到合适供体的可能性。使用来自NMDP供体和脐带血单位登记处的人类HLA数据，我们为21个美国种族和民族建立了基于人群的遗传模型，以预测为每组患者确定合适供体（成人供体或脐带血单位）的可能性。这些模型结合了HLA匹配程度、成人供体可用性（即，捐献能力）和脐带血单位细胞剂量。我们的模型表明，HSCT的大多数候选人将有一个合适的（HLA匹配或最小错配）成人供体。然而，许多患者不会有最佳的成人供体-也就是说，在HLA-A，HLA-B，HLA-C和HLA-DRB 1上以高分辨率匹配的供体。找到最佳供体的可能性因种族和民族而异，欧洲血统的白人的可能性最高，为75%，南美洲或中美洲血统的黑人的可能性最低，为16%。其他群体的可能性是中等的。很少有患者会有一个最佳的脐带血单位-也就是说，一个匹配的抗原水平在HLA-A和HLA-B和匹配的高分辨率在HLA-DRB 1。然而，在一个或两个HLA位点不匹配的脐带血单位可用于几乎所有的患者年龄小于20岁，超过80%的患者年龄20岁或以上，无论种族和民族背景。大多数可能受益于HSCT的患者将有供体。对献血者招募和脐带血库的公共投资扩大了HSCT的可及性。（由海军部海军研究办公室和卫生与公众服务部卫生资源和服务管理局资助。）
Hematopoietic stem-cell transplantation (HSCT) is a potentially lifesaving therapy for several blood cancers and other diseases. For patients without a suitable related HLA-matched donor, unrelated-donor registries of adult volunteers and banked umbilical cord–blood units, such as the Be the Match Registry operated by the National Marrow Donor Program (NMDP), provide potential sources of donors. Our goal in the present study was to measure the likelihood of finding a suitable donor in the U.S. registry. Using human HLA data from the NMDP donor and cord-blood-unit registry, we built population-based genetic models for 21 U.S. racial and ethnic groups to predict the likelihood of identifying a suitable donor (either an adult donor or a cord-blood unit) for patients in each group. The models incorporated the degree of HLA matching, adult-donor availability (i.e., ability to donate), and cord-blood-unit cell dose. Our models indicated that most candidates for HSCT will have a suitable (HLA-matched or minimally mismatched) adult donor. However, many patients will not have an optimal adult donor — that is, a donor who is matched at high resolution at HLA-A, HLA-B, HLA-C, and HLA-DRB1. The likelihood of finding an optimal donor varies among racial and ethnic groups, with the highest probability among whites of European descent, at 75%, and the lowest probability among blacks of South or Central American descent, at 16%. Likelihoods for other groups are intermediate. Few patients will have an optimal cord-blood unit — that is, one matched at the antigen level at HLA-A and HLA-B and matched at high resolution at HLA-DRB1. However, cord-blood units mismatched at one or two HLA loci are available for almost all patients younger than 20 years of age and for more than 80% of patients 20 years of age or older, regardless of racial and ethnic background. Most patients likely to benefit from HSCT will have a donor. Public investment in donor recruitment and cord-blood banks has expanded access to HSCT. (Funded by the Office of Naval Research, Department of the Navy, and the Health Resources and Services Administration, Department of Health and Human Services.)