Hansen J A, Anasetti C, Martin P J, Mickelson E M, Petersdorf E, Thomas E D
Fred Hutchinson Cancer Research Center, Department of Medicine, University of Washington, Seattle.
Clin Transpl. 1993:193-209.
Allogeneic marrow transplantation from a normal donor provides potential life-saving therapy for a variety of inherited and acquired diseases of the hematopoietic and immune systems including malignancies. However, even with an HLA-identical sibling donor the success of allografts can be compromised by GvHD and associated complications such as opportunistic infection. Non-HLA minor histocompatibility determinants still represent significant barriers to safe and successful transplants in some cases. In the absence of an HLA-identical sibling, alternate donors, including HLA-matched unrelated volunteers and HLA partially matched relatives can provide opportunity for effective therapy, though with increased risk of graft rejection and GvHD. HLA matching appears to be a critical factor, with the incidence and severity of GvHD exceeding acceptable limits as the number of incompatible HLA antigens increases. Although the United States NMDP and the marrow donor registries in other countries that currently have more than 1.2 million HLA-typed donors have profoundly improved the likelihood of finding an HLA-matched unrelated donor for the majority of White patients, many Whites and most patients of other racial origin cannot at this time find a match. Effective and safe treatment for these patients will require improved methods for managing HLA-mismatched transplants.
来自正常供体的异基因骨髓移植为包括恶性肿瘤在内的多种造血系统和免疫系统的遗传性及后天性疾病提供了潜在的挽救生命的治疗方法。然而，即使有 HLA 匹配的同胞供体，移植物的成功仍可能受到移植物抗宿主病（GvHD）及相关并发症（如机会性感染）的影响。在某些情况下，非 HLA 次要组织相容性决定簇仍是安全且成功移植的重大障碍。在没有 HLA 匹配的同胞供体时，包括 HLA 匹配的无关志愿者和 HLA 部分匹配的亲属在内的替代供体可为有效治疗提供机会，尽管移植排斥和 GvHD 的风险会增加。HLA 匹配似乎是一个关键因素，随着不相容 HLA 抗原数量的增加，GvHD 的发生率和严重程度会超过可接受的限度。尽管美国国家骨髓捐赠计划（NMDP）和其他国家目前拥有超过 120 万 HLA 分型供体的骨髓捐赠登记处极大地提高了大多数白人患者找到 HLA 匹配无关供体的可能性，但目前许多白人以及大多数其他种族的患者仍无法找到匹配的供体。对这些患者进行有效且安全的治疗将需要改进管理 HLA 不匹配移植的方法。
