The impact of HLA matching on unrelated donor hematopoietic stem cell transplantation in Korean children.
The impact of HLA matching on unrelated donor hematopoietic stem cell transplantation in Korean children.
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DOI：
10.5045/kjh.2011.46.1.11
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发表时间：
2011-03
期刊：
影响因子：
--
通讯作者：
Seo JJ
中科院分区：
文献类型：
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作者：
Park M;Koh KN;Kim BE;Im HJ;Park KD;Kang HJ;Shin HY;Ahn HS;Yoo KH;Sung KW;Koo HH;Park HJ;Park BK;Seo JJ
HLA配型对非亲缘供者（URD）造血干细胞移植（HSCT）结局的影响在不同种族或民族中存在差异。由于很少有人知道这种匹配的影响URD HSCT在韩国儿童，我们分析了这个问题。我们分析了142例在4个韩国医疗中心接受URD HSCT的患者的结局。对所有患者供体对进行HLA-A、-B、-C和-DR等位基因的完全分型。在中位随访22个月时，具有8、7和≤6个匹配等位基因的患者的3年生存率分别为88.4%、70.7%和53.6%。HLA-B或-C的单个错配（Mm）与8个匹配等位基因相关的生存率较低相关。在存活率或急性移植物抗宿主病（aGVHD）发生率方面，单等位基因和单抗原Mms之间没有观察到显著差异。与低风险恶性肿瘤患者相比，HLA差异对高风险恶性肿瘤患者的生存影响更大。在具有单个Mm的配对中，与具有8个匹配等位基因的患者相比，仅基因座A显示出显著关联和更高的III-IV级aGVHD风险。无论抗原或等位基因Mm如何，HLA I类的差异都对存活率和III-IV级aGVHD的发展产生不利影响。HLA Mms数量的增加与移植后并发症的风险增加相关。需要使用更大的队列进行进一步研究，以确认HLA错配对URD HSCT患者结局的影响。
The impact of HLA matching on outcomes of unrelated donor (URD) hematopoietic stem cell transplantation (HSCT) varies in different racial or ethnic groups. Since little is known about the impact of such matching on URD HSCT in Korean children, we analyzed this issue. We analyzed the outcomes of 142 patients who underwent URD HSCT at 4 Korean medical centers. All patient donor pairs were fully typed for HLA-A, -B, -C, and -DR alleles. At a median follow-up of 22 months, 3-year survival rates for patients with 8, 7, and ≤6 matched alleles were 88.4%, 70.7%, and 53.6%, respectively. A single mismatch (Mm) at HLA-B or -C was associated with lower survival compared with that associated with 8 matched alleles. No significant differences were observed between single-allele and single-antigen Mms with respect to survival rate or acute graft-versus-host disease (aGVHD) incidence rates. HLA disparity had a greater impact on the survival of patients with high-risk malignancy than of those with low-risk malignancy. Among pairs with a single Mm, only locus A showed a significant association and higher risk of grade III-IV aGVHD compared to those in patients with 8 matched alleles. Disparity in HLA class I, regardless of antigen or allele Mm, adversely affected both survival and grade III-IV aGVHD development. An increased number of HLA Mms was associated with a higher risk of post-transplantation complications. Further investigations using larger cohorts are required to confirm the effects of HLA mismatching on URD HSCT patient outcomes.