Petersdorf Effie W
University of Washington School of Medicine, Fred Hutchinson Cancer Research Center, Division of Clinical Research, Seattle, Washington 98109, USA.
Curr Opin Hematol. 2004 Nov;11(6):386-91. doi: 10.1097/01.moh.0000143701.88042.d9.
The success of unrelated hematopoietic cell transplantation (HCT) is influenced by the degree of HLA compatibility between the donor and patient. The goal of this review is to summarize new findings in the field of immunogenetics and HCT from unrelated donors using myeloablative conditioning regimens.
Molecular typing methods can discriminate unique alleles encoded by HLA class I and II genes. Incompatibility of donor-recipient HLA alleles increases posttransplant complications including graft rejection, acute and chronic graft-versus-host disease, and mortality. These posttransplant risks increase with increasing numbers of HLA mismatches. The identification of permissible HLA mismatches may be aided by the use of functional assays. Nongenetic factors, including the stage of disease at the time of transplantation, may influence the effect of HLA mismatching on survival.
HLA alleles are functionally relevant. Unrelated HCT can be optimized by comprehensive and precise donor-recipient allele matching. For patients with high-risk diseases who lack matched donors, use of donors with a single HLA mismatch may permit early treatment before disease progression.
非亲缘造血细胞移植（HCT）的成功受供者与患者之间HLA相容性程度的影响。本综述的目的是总结免疫遗传学领域以及采用清髓性预处理方案的非亲缘供者HCT的新发现。
分子分型方法能够区分由HLAⅠ类和Ⅱ类基因编码的独特等位基因。供受者HLA等位基因不相容会增加移植后并发症的发生，包括移植物排斥、急慢性移植物抗宿主病以及死亡率。随着HLA错配数目的增加，这些移植后风险也会增加。使用功能测定可能有助于识别可允许的HLA错配。非遗传因素，包括移植时的疾病阶段，可能会影响HLA错配对生存的影响。
HLA等位基因具有功能相关性。通过全面且精确的供受者等位基因匹配可优化非亲缘HCT。对于缺乏匹配供者的高危疾病患者，使用具有单个HLA错配的供者可能允许在疾病进展前尽早进行治疗。
