Beatty P G, Clift R A, Mickelson E M, Nisperos B B, Flournoy N, Martin P J, Sanders J E, Stewart P, Buckner C D, Storb R
N Engl J Med. 1985 Sep 26;313(13):765-71. doi: 10.1056/NEJM198509263131301.
Marrow transplantation has generally been limited to patients with a sibling who is genotypically identical for HLA. In a study of the acceptable limits of HLA incompatibility, 105 consecutive patients with hematologic cancers who received marrow grafts from haploidentical donors (study group) were compared with 728 similar patients concurrently receiving grafts from HLA genotypically identical siblings (control group). The unshared haplotypes differed variably: 12 were phenotypically but not genotypically identical for HLA-A, HLA-B, and HLA-D; 63 differed at one locus (A, B, or D); 24 at two loci; and 6 at three. A higher proportion of study patients had delayed engraftment, granulocytopenia, or graft rejection. Acute graft versus host disease occurred earlier and with greater frequency in study patients. The risk of the disease did not correlate with disparity for Class I (A or B) versus Class II (D-region) loci. Thus, incompatibility for HLA has an important effect on the course after clinical marrow transplantation. In spite of these complications, there was no statistically significant difference in the survival of the study patients and control patients who received their transplants during remission.
骨髓移植通常仅限于有基因分型与 HLA 完全相同的同胞的患者。在一项关于 HLA 不相容性可接受限度的研究中，将 105 例连续接受单倍体相合供者骨髓移植的血液系统癌症患者（研究组）与 728 例同时接受 HLA 基因分型相同的同胞供者骨髓移植的类似患者（对照组）进行了比较。未共享的单倍型差异程度各不相同：12 例在 HLA - A、HLA - B 和 HLA - D 表型相同但基因分型不同；63 例在一个位点（A、B 或 D）存在差异；24 例在两个位点存在差异；6 例在三个位点存在差异。研究组患者中移植延迟、粒细胞减少或移植排斥的比例更高。急性移植物抗宿主病在研究组患者中出现得更早且频率更高。该病的风险与 I 类（A 或 B）位点与 II 类（D 区）位点的差异无关。因此，HLA 不相容性对临床骨髓移植后的病程有重要影响。尽管有这些并发症，但在缓解期接受移植的研究组患者和对照组患者的生存率没有统计学上的显著差异。
