Effect of HLA mismatch on acute graft-versus-host disease
Effect of HLA mismatch on acute graft-versus-host disease
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DOI：
10.1007/s12185-013-1405-x
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发表时间：
2013-09-01
影响因子：
2.1
通讯作者：
Kanda, Junya
中科院分区：
文献类型：
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作者：
Kanda, Junya
供受者HLA配型是异基因造血干细胞移植后发生急性移植物抗宿主病（GVHD）的重要因素。随着GVHD预防和支持性治疗的改善，HLA不匹配供体的移植越来越频繁，引起了人们对HLA不匹配影响的更多关注。在相关移植中，HLA-A、HLA-B和HLA-DR位点的HLA 1抗原错配被认为是可接受的，但在标准预防下严重急性GVHD的发生率高于匹配的相关和无关移植，突出了对GVHD预防的修改的需要。新的GVHD免疫缺陷的发展使HLA 2-3抗原不匹配的相关移植成为可能，并且几乎克服了HLA屏障。在无关骨髓或外周血干细胞移植中，HLA-A、HLA-B、HLA-C和HLA-DRB 1等位基因匹配的供体是最优选的。等位基因或抗原错配的影响已经在许多研究中进行了评估，但这些研究的结果并不一致，部分原因是种族和HLA分布的差异。HLA错配的影响可能会有所不同，这取决于移植的年份和GVHD预防的形式。在脐带血移植中，成功的移植可以在最多两个HLA错配的情况下实现。在儿童中，与使用HLA不匹配的单位相比，使用HLA匹配的单位与急性GVHD和死亡率的较低风险相关，而在成人中，HLA不匹配可能对结局的影响较低。因此，HLA配型的效果应分别评估不同的干细胞来源。
HLA matching between donors and recipients is the most important factor associated with acute graft-versus-host disease (GVHD) following allogeneic hematopoietic stem cell transplantation. With improvements in GVHD prophylaxis and supportive care, transplantations from HLA mismatched donors are performed increasingly frequently, drawing greater attention to the effects of HLA mismatch. In related transplantation, HLA 1-antigen mismatch at the HLA-A, HLA-B, and HLA-DR loci is considered acceptable, but the incidence of severe acute GVHD under standard prophylaxis is higher than that for matched related and unrelated transplantation, highlighting the need for a modification of GVHD prophylaxis. Development of new GVHD prophylaxes has now made HLA 2-3-antigen mismatched related transplantation feasible, and has almost overcome the HLA barrier. In unrelated bone marrow or peripheral blood stem cell transplantation, donors matched for HLA-A, HLA-B, HLA-C, and HLA-DRB1 alleles are the most preferable. The impact of allele or antigen mismatch has been evaluated in a number of studies, but the results of these have not been consistent, partly due to differences in race and HLA distribution. The effects of HLA mismatch may differ depending on the year of transplantation and the form of GVHD prophylaxis administered. In cord blood transplantation, successful transplantation can be achieved with up to two HLA mismatches. In children, compared to the use of HLA mismatched units, the use of HLA-matched units is associated with a lower risk of acute GVHD and mortality, while in adults HLA mismatches may have a lower impact on outcome. Thus, the effect of HLA matching should be evaluated separately for different stem cell sources.