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如何选择最佳的造血干细胞相关或无关供体?

How to select the best available related or unrelated donor of hematopoietic stem cells?

作者信息

Tiercy Jean-Marie

机构信息

National Reference Laboratory for Histocompatibility, Department of Genetic and Laboratory Medicine, University Hospitals Geneva, Switzerland

出版信息

Haematologica. 2016 Jun;101(6):680-7. doi: 10.3324/haematol.2015.141119. Epub 2016 May 31.

Abstract

Recognition of HLA incompatibilities by the immune system represents a major barrier to allogeneic hematopoietic stem cell transplantation. HLA genotypically identical sibling donors are, therefore, the gold standard for transplantation purposes, but only 30% patients have such a donor. For the remaining 70% patients alternative sources of stem cells are a matched unrelated adult volunteer donor, a haploidentical donor or a cord blood unit. The definition of 'HLA matching' depends on the level of resolution and on which loci are tested. The development of HLA molecular typing technologies and the availability of more than 27 million donors in the international database has greatly facilitated unrelated donor searches. The gold standard is high resolution typing at the HLA-A, -B, -C, -DRB1, and -DQB1 loci (10/10 match). Single disparities for HLA-A, -B, - C, or -DRB1 are associated with increased risk of post-transplant complications, but less so in patients with advanced disease, and in those undergoing T-cell-depleted allografting. HLA-DQB1 mismatches seem to be better tolerated and some HLA-C, -DRB1 and -DPB1 disparities are potentially less immunogenic. HLA typing by next-generation sequencing methods is likely to change matching algorithms by providing full sequence information on all HLA loci in a single step. In most European populations a 10/10 matched donor can be found for at least 50% of patients and an additional 20-30% patients may have a 9/10 matched donor. Genetic factors that help in identifying donors with less immunogenic mismatches are discussed. Haploidentical donors are increasingly used as an alternative source of stem cells for those patients lacking a matched unrelated donor.

摘要

免疫系统识别HLA不相容性是异基因造血干细胞移植的主要障碍。因此,HLA基因型相同的同胞供体是移植的金标准,但只有30%的患者有这样的供体。对于其余70%的患者,干细胞的替代来源是匹配的无关成年志愿供体、单倍体相同供体或脐带血单位。“HLA匹配”的定义取决于分辨率水平和所检测的基因座。HLA分子分型技术的发展以及国际数据库中超过2700万供体的可获得性极大地促进了无关供体的搜索。金标准是在HLA-A、-B、-C、-DRB1和-DQB1基因座进行高分辨率分型(10/10匹配)。HLA-A、-B、-C或-DRB1的单个差异与移植后并发症风险增加相关,但在晚期疾病患者和接受T细胞去除同种异体移植的患者中相关性较小。HLA-DQB1错配似乎耐受性更好,一些HLA-C、-DRB1和-DPB1差异的免疫原性可能较低。通过下一代测序方法进行HLA分型可能会通过一步提供所有HLA基因座的完整序列信息来改变匹配算法。在大多数欧洲人群中,至少50%的患者可以找到10/10匹配的供体,另外20-30%的患者可能有9/10匹配的供体。文中讨论了有助于识别免疫原性较低错配供体的遗传因素。对于那些缺乏匹配无关供体的患者,单倍体相同供体越来越多地被用作干细胞的替代来源。

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