MARROW TRANSPLANTATION FROM RELATED DONORS OTHER THAN HLA-IDENTICAL SIBLINGS
MARROW TRANSPLANTATION FROM RELATED DONORS OTHER THAN HLA-IDENTICAL SIBLINGS
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DOI：
10.1056/nejm198509263131301
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发表时间：
1985-01-01
影响因子：
158.5
通讯作者：
HANSEN, JA
中科院分区：
文献类型：
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作者：
BEATTY, PG;CLIFT, RA;HANSEN, JA
骨髓移植通常仅限于具有HLA基因型相同的同胞的患者。在一项HLA不相容性可接受限度的研究中，将105例接受来自单倍体相合供者骨髓移植的连续血液学癌症患者（研究组）与728例同时接受来自HLA基因型相合同胞骨髓移植的相似患者（对照组）进行了比较。非共享的单倍型差异很大：12个HLA-A、HLA-B和HLA-D的表型不同，但基因型不同; 63个在一个位点（A、B或D）不同; 24个在两个位点不同; 6个在三个位点不同。较高比例的研究患者有植入延迟、粒细胞减少或移植物排斥。急性移植物抗宿主病在研究患者中发生更早，频率更高。该疾病的风险与I类（A或B）与II类（D区）基因座的差异无关。因此，HLA不相容性对临床骨髓移植后的病程有重要影响。尽管存在这些并发症，但在缓解期接受移植的研究患者和对照患者的生存率没有统计学显著差异。
Marrow transplantation has generally been limited to patients with a sibling who is genotypically identical for HLA. In a study of the acceptable limits of HLA incompatibility, 105 consecutive patients with hematologic cancers who received marrow grafts from haploidentical donors (study group) were compared with 728 similar patients concurrently receiving grafts from HLA genotypically identical siblings (control group). The unshared haplotypes differed variably: 12 were phenotypically but not genotypically identical for HLA-A, HLA-B, and HLA-D; 63 differed at one locus (A, B, or D); 24 at two loci; and 6 at three. A higher proportion of study patients had delayed engraftment, granulocytopenia, or graft rejection. Acute graft versus host disease occurred earlier and with greater frequency in study patients. The risk of the disease did not correlate with disparity for Class I (A or B) versus Class II (D-region) loci. Thus, incompatibility for HLA has an important effect on the course after clinical marrow transplantation. In spite of these complications, there was no statistically significant difference in the survival of the study patients and control patients who received their transplants during remission.