Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan,
Int J Hematol. 2013 Sep;98(3):300-8. doi: 10.1007/s12185-013-1405-x. Epub 2013 Jul 28.
HLA matching between donors and recipients is the most important factor associated with acute graft-versus-host disease (GVHD) following allogeneic hematopoietic stem cell transplantation. With improvements in GVHD prophylaxis and supportive care, transplantations from HLA mismatched donors are performed increasingly frequently, drawing greater attention to the effects of HLA mismatch. In related transplantation, HLA 1-antigen mismatch at the HLA-A, HLA-B, and HLA-DR loci is considered acceptable, but the incidence of severe acute GVHD under standard prophylaxis is higher than that for matched related and unrelated transplantation, highlighting the need for a modification of GVHD prophylaxis. Development of new GVHD prophylaxes has now made HLA 2-3-antigen mismatched related transplantation feasible, and has almost overcome the HLA barrier. In unrelated bone marrow or peripheral blood stem cell transplantation, donors matched for HLA-A, HLA-B, HLA-C, and HLA-DRB1 alleles are the most preferable. The impact of allele or antigen mismatch has been evaluated in a number of studies, but the results of these have not been consistent, partly due to differences in race and HLA distribution. The effects of HLA mismatch may differ depending on the year of transplantation and the form of GVHD prophylaxis administered. In cord blood transplantation, successful transplantation can be achieved with up to two HLA mismatches. In children, compared to the use of HLA mismatched units, the use of HLA-matched units is associated with a lower risk of acute GVHD and mortality, while in adults HLA mismatches may have a lower impact on outcome. Thus, the effect of HLA matching should be evaluated separately for different stem cell sources.
供者与受者之间的 HLA 配型是异基因造血干细胞移植后发生急性移植物抗宿主病（GVHD）的最重要因素。随着 GVHD 预防和支持治疗的改善，越来越频繁地进行 HLA 不匹配供者的移植，这引起了对 HLA 不匹配影响的更多关注。在亲缘移植中，HLA-A、HLA-B 和 HLA-DR 位点的 1 抗原不匹配被认为是可以接受的，但在标准预防方案下，严重急性 GVHD 的发生率高于匹配的亲缘和无关移植，这突出了需要修改 GVHD 预防方案。新的 GVHD 预防方案的发展使 HLA 2-3 抗原不匹配的亲缘移植成为可能，并且几乎克服了 HLA 障碍。在无关的骨髓或外周血干细胞移植中，HLA-A、HLA-B、HLA-C 和 HLA-DRB1 等位基因匹配的供者是最理想的。已经评估了等位基因或抗原不匹配在一些研究中的影响，但这些研究的结果并不一致，部分原因是种族和 HLA 分布的差异。HLA 不匹配的影响可能因移植年份和所使用的 GVHD 预防方案而有所不同。在脐血移植中，最多可以有两个 HLA 不匹配即可实现成功移植。在儿童中，与使用 HLA 不匹配的单位相比，使用 HLA 匹配的单位与急性 GVHD 和死亡率较低相关，而在成人中，HLA 不匹配对结果的影响可能较小。因此，应根据不同的干细胞来源分别评估 HLA 匹配的效果。
