Details

Autor(en) / Beteiligte

• Fernández-Viña, Marcelo A.
• Klein, John P.
• Haagenson, Michael
• Spellman, Stephen R.
• Anasetti, Claudio
• Noreen, Harriet
• Baxter-Lowe, Lee Ann
• Cano, Pedro
• Flomenberg, Neal
• Confer, Dennis L.
• Horowitz, Mary M.
• Oudshoorn, Machteld
• Petersdorf, Effie W.
• Setterholm, Michelle
• Champlin, Richard
• Lee, Stephanie J.
• de Lima, Marcos

Titel

Multiple mismatches at the low expression HLA loci DP, DQ, and DRB3/4/5 associate with adverse outcomes in hematopoietic stem cell transplantation

Ist Teil von

• Blood, 2013-05, Vol.121 (22), p.4603-4610

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2013

Quelle

MEDLINE

Beschreibungen/Notizen

• A single mismatch in highly expressed HLA-A, -B, -C, and -DRB1 loci (HEL) is associated with worse outcomes in hematopoietic stem cell transplantation, while less is known about the cumulative impact of mismatches in the lesser expressed HLA loci DRB3/4/5, DQ, and DP (LEL). We studied whether accumulation of LEL mismatches is associated with deleterious effects in 3853 unrelated donor transplants stratified according to number of matches in the HEL. In the 8/8 matched HEL group, LEL mismatches were not associated with any adverse outcome. Mismatches at HLA-DRB1 were associated with occurrence of multiple LEL mismatches. In the 7/8 HEL group, patients with 3 or more LEL mismatches scored in the graft-versus-host vector had a significantly higher risk of mortality (1.45 and 1.43) and transplant-related mortality (1.68 and 1.54) than the subgroups with 0 or 1 LEL mismatches. No single LEL locus had a more pronounced effect on clinical outcome. Three or more LEL mismatches are associated with lower survival after 7/8 HEL matched transplantation. Prospective evaluation of matching for HLA-DRB3/4/5, -DQ, and -DP loci is warranted to reduce posttransplant risks in donor-recipient pairs matched for 7/8 HEL. •Three or more mismatches at the Low Expression Loci may adversely affect clinical outcome after 7/8 matched transplantation.•Match grade at the Low Expression HLA Loci may be considered to select 7/8 donors with potentially lower posttransplant risks.