Anasetti C, Etzioni R, Petersdorf E W, Martin P J, Hansen J A
Immunogenetics Program, Fred Hutchinson Cancer Research Center, Seattle, Washington 98104, USA.
Annu Rev Med. 1995;46:169-79. doi: 10.1146/annurev.med.46.1.169.
Marrow transplants from human leukocyte antigen (HLA)-compatible unrelated volunteer donors have become feasible for more than 30% of patients without a family match and have allowed long-term, disease-free survival in 15-65% of patients with a variety of hematological disorders. However, unrelated donor transplants have a higher incidence of graft failure and graft versus host disease (GVHD) than do HLA-matched sibling transplants. This increase may be due to disparities between donor and recipient for undetected HLA determinants or for non-HLA histocompatibility genes. Because of the large number of HLA loci and their high degree of polymorphism, fully compatible donors will not be found for most patients. Fortunately, a limited degree of HLA mismatch does not necessarily impair long-term survival in patients with hematologic malignancy. Current studies are defining the risk associated with mismatching for each histocompatibility locus and are developing methods for marrow transplantation that can decrease morbidity and improve survival despite genetic disparity between donor and recipient.
对于超过30%没有家族匹配供者的患者来说，来自人类白细胞抗原（HLA）匹配的无关志愿供者的骨髓移植已成为可行的办法，并且使15%至65%患有各种血液系统疾病的患者获得了长期无病生存。然而，与HLA匹配的同胞供者移植相比，无关供者移植的移植物失败和移植物抗宿主病（GVHD）发生率更高。这种增加可能是由于供者和受者之间在未检测到的HLA决定簇或非HLA组织相容性基因方面存在差异。由于HLA位点数量众多且具有高度多态性，大多数患者将找不到完全匹配的供者。幸运的是，有限程度的HLA不匹配不一定会损害血液系统恶性肿瘤患者的长期生存。目前的研究正在确定每个组织相容性位点不匹配相关的风险，并正在开发骨髓移植方法，尽管供者和受者之间存在基因差异，但这些方法可以降低发病率并提高生存率。
