Evaluation of HLA matching in unrelated hematopoietic stem cell transplantation for nonmalignant disorders
Evaluation of HLA matching in unrelated hematopoietic stem cell transplantation for nonmalignant disorders
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DOI：
10.1182/blood-2012-03-417758
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发表时间：
2012-10-04
期刊：
影响因子：
20.3
通讯作者：
Woolfrey, Ann
中科院分区：
文献类型：
--
作者：
Horan, John;Wang, Tao;Woolfrey, Ann
人类白细胞抗原（HLA）配型在非亲缘供者移植治疗非恶性疾病（NMD）中的重要性尚未明确。我们分析了1995年至2007年为治疗NMD而进行的663例无关骨髓和外周血干细胞移植的数据。多变量分析显示，HLA-A、-B、-C或-DRB 1位点不匹配，而非-DQB 1或-DPB 1位点不匹配的供者的移植与较高的死亡率相关（P = 0.002）。与8/8例匹配移植相比，单次（7/8）和双次不匹配（6/8）移植的死亡风险比分别为1.29（0.97-1.72; P = 0.079）和1.82（1.30-2.55; P = 0.0004）。HLA错配与急性或慢性GVHD无关，但与移植失败密切相关。校正其他因素后，7/8和6/8（等位基因和/或抗原）匹配对与8/8匹配移植相比，移植失败的比值比分别为2.81（1.74-4.54; P <0.0001）和2.22（1.26-3.97; P = 0.006）。如果可能的话，NMD患者应接受等位基因匹配（8/8）供体的移植。与恶性肿瘤不同的是，NMD中的HLA错配与移植物衰竭而不是GVHD相关。（血。2012; 120（14）：2918-2924）
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. (Blood. 2012; 120(14): 2918-2924)