Leung W H, Turner V, Richardson S L, Benaim E, Hale G, Horwitz E M, Woodard P, Bowman L C
Department of Hematology-Oncology, Laboratory Medicine and Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
Hum Immunol. 2001 Apr;62(4):399-407. doi: 10.1016/s0198-8859(01)00220-8.
The degree of histoincompatibility that can be tolerated, and the relative importance of matching at individual HLA class I and class II locus in bone marrow transplantation (BMT) has not been established. We hypothesized that matching for HLA-DR may not be more important than matching for HLA-A or HLA-B in selection of a donor for successful BMT. We retrospectively analyzed the outcomes of 248 consecutive pediatric patients who received allogeneic BMT from related donors (RD, n = 119) or unrelated donors (URD, n = 129). HLA-A and HLA-B were serologically matched, and HLA-DRB1 were identical by DNA typing in 69% of donor-recipient pairs. Most patients (89%) had hematologic malignancies; the rest had aplastic anemia or a congenital disorder. One HLA-A antigen mismatch was associated with a decrease in survival (p = 0.003) and a delay in granulocyte engraftment (p = 0.02) in recipients of RD marrow; as well as a decrease in survival (p = 0.02) and the development of severe acute graft-versus-host disease (GVHD) (p = 0.03) in recipients of URD marrow. One HLA-B antigen mismatch was associated with a decrease in the survival (p = 0.05) and the development of severe GVHD (p = 0.0007) in recipients of RD marrow. One HLA-DRB1 allele mismatch was associated only with a decrease in the survival (p = 0.0003) of recipients of RD marrow. Results of this study suggest that disparity in HLA-A and HLA-B antigens may not be better tolerated than disparity in HLA-DR allele in allogeneic BMT. Further studies are warranted to confirm our results.
骨髓移植（BMT）中可耐受的组织不相容程度以及个体HLA I类和II类位点匹配的相对重要性尚未确定。我们假设在选择成功进行BMT的供体时，HLA - DR匹配可能并不比HLA - A或HLA - B匹配更重要。我们回顾性分析了248例连续接受来自相关供体（RD，n = 119）或无关供体（URD，n = 129）的异基因BMT的儿科患者的结局。69%的供体 - 受体对中HLA - A和HLA - B血清学匹配，HLA - DRB1通过DNA分型相同。大多数患者（89%）患有血液系统恶性肿瘤；其余患者患有再生障碍性贫血或先天性疾病。在接受RD骨髓的患者中，一个HLA - A抗原错配与生存率降低（p = 0.003）和粒细胞植入延迟（p = 0.02）相关；在接受URD骨髓的患者中，还与生存率降低（p = 0.02）和严重急性移植物抗宿主病（GVHD）的发生（p = 0.03）相关。在接受RD骨髓的患者中，一个HLA - B抗原错配与生存率降低（p = 0.05）和严重GVHD的发生（p = 0.0007）相关。一个HLA - DRB1等位基因错配仅与接受RD骨髓的患者的生存率降低（p = 0.0003）相关。本研究结果表明，在异基因BMT中，HLA - A和HLA - B抗原的差异可能并不比HLA - DR等位基因的差异更能被耐受。有必要进行进一步研究以证实我们的结果。
