Acceptable HLA-mismatching in unrelated donor bone marrow transplantation for patients with acquired severe aplastic anemia

Author:

Yagasaki Hiroshi12,Kojima Seiji2,Yabe Hiromasa3,Kato Koji4,Kigasawa Hisato5,Sakamaki Hisashi6,Tsuchida Masahiro7,Kato Shunichi3,Kawase Takakazu8,Morishima Yasuo9,Kodera Yoshihisa10,

Affiliation:

1. Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan;

2. Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan;

3. Department of Cell Transplantation and Regenerative Medicine, Tokai University School of Medicine, Isehara, Japan;

4. Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan;

5. Kanagawa Children's Hospital, Yokohama, Japan;

6. Department of Hematology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan;

7. Ibaragi Children's Hospital, Mito, Japan;

8. Division of Immunology, Aichi Cancer Center, Nagoya, Japan;

9. Department of Hematology and Cell Therapy, Aichi Cancer Center, Nagoya, Japan; and

10. Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University School of Medicine, Nagakute, Japan

Abstract

Abstract We retrospectively analyzed the effect of HLA mismatching (HLA-A, -B, -C, -DRB1, -DQB1) with molecular typing on transplantation outcome for 301 patients with acquired severe aplastic anemia (SAA) who received an unrelated BM transplant through the Japan Marrow Donor Program. Additional effect of HLA-DPB1 mismatching was analyzed for 10 of 10 or 9 of 10 HLA allele-matched pairs (n = 169). Of the 301 recipient/donor pairs, 101 (33.6%) were completely matched at 10 of 10 alleles, 69 (23%) were mismatched at 1 allele, and 131 (43.5%) were mismatched at ≥ 2 alleles. Subjects were classified into 5 subgroups: complete match group (group I); single-allele mismatch group (groups II and III); multiple alleles restricted to HLA-C, -DRB1, and -DQB1 mismatch group (group IV); and others (group V). Multivariate analysis indicated that only HLA disparity of group V was a significant risk factor for poor survival and grade II-IV acute GVHD. HLA-DPB1 mismatching was not associated with any clinical outcome. We recommend the use of an HLA 10 of 10 allele-matched unrelated donor. However, if such a donor is not available, any single-allele or multiple-allele (HLA-C, -DRB1, -DQB1) mismatched donor is acceptable as an unrelated donor for patients with severe aplastic anemia.

Publisher

American Society of Hematology

Subject

Cell Biology,Hematology,Immunology,Biochemistry

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