Nagler A, Brautbar C, Slavin S, Bishara A
Bone Marrow Transplantation Department, Hadassah University Hospital, Jerusalem, Israel.
Bone Marrow Transplant. 1996 Nov;18(5):891-7.
The clinical outcomes of unrelated and of family related allogeneic bone marrow transplantation (BMT) were correlated with HLA disparity in a study in which molecular phenotyping of HLA-C was performed for unrelated donor-recipient pairs. The study included 30 patients who underwent BMT from unrelated donors and 43 patients who underwent BMT from family related donors. The unrelated group included 14 full match pairs, 12 class-I-C (molecular HLA-C) mismatched pairs, and 4 haploidentical pairs. The family related group included 9 full match pairs, 19 class-I mismatched pairs, and 15 haploidentical pairs. In the unrelated BMT group, the transplant-related complications of mortality, graft-versus-host disease (GVHD), and graft rejection, were significantly higher in molecular HLA-C mismatched than matched patients (67% vs 14%, P < 0.02; 50% vs 7%, P < 0.02; 42% vs 0, P < 0.02). The actuarial survival and the disease free survival (DFS) at 18 months was better for molecular HLA-C matched than for HLA-C mismatched unrelated transplants: 33% vs 18% (P = 0.065, NS), and 29% vs 16%, respectively. For the family related BMT group, the actuarial survival at 18 months was significantly higher for patients who were fully matched compared to those who were class-I mismatched, or those who were haploidentical pairs: 67%, 37%, and 13% respectively (P < 0.02). The actuarial DFS at 18 months of patients who were fully matched and of those who were class-I mismatched was similar, and better than that of haploidentical patients 45%, 37% (NS) and 13% respectively (P < 0.045). A lower incidence of transplant-related mortality occurred in class-I mismatched, family related (37%) than in locus-C mismatched unrelated patients (67%), and no difference was observed in the fully matched family related and unrelated patients. We conclude that a mismatch in locus C may be detrimental to BMT outcome and should therefore be included as a risk factor in the routine pre-BMT HLA phenotyping.
在一项针对非亲属和亲属间异基因骨髓移植（BMT）的研究中，对非亲属供受者对进行了HLA - C分子表型分析，其临床结果与HLA差异相关。该研究包括30例接受非亲属供者BMT的患者和43例接受亲属供者BMT的患者。非亲属组包括14个完全匹配对、12个I类 - C（分子HLA - C）错配对和4个单倍型相同对。亲属组包括9个完全匹配对、19个I类错配对和15个单倍型相同对。在非亲属BMT组中，分子HLA - C错配患者的移植相关并发症死亡率、移植物抗宿主病（GVHD）和移植物排斥反应显著高于匹配患者（67%对14%，P < 0.02；50%对7%，P < 0.02；42%对0，P < 0.02）。分子HLA - C匹配的非亲属移植在18个月时的精算生存率和无病生存率（DFS）优于HLA - C错配的非亲属移植：分别为33%对18%（P = 0.065，无统计学意义）和29%对16%。对于亲属BMT组，18个月时完全匹配患者的精算生存率显著高于I类错配患者或单倍型相同对患者：分别为67%、37%和13%（P < 0.02）。完全匹配患者和I类错配患者在18个月时的精算DFS相似，且优于单倍型相同患者，分别为45%、37%（无统计学意义）和13%（P < 0.045）。I类错配的亲属患者（37%）移植相关死亡率低于C位点错配的非亲属患者（67%），完全匹配的亲属和非亲属患者之间未观察到差异。我们得出结论，C位点错配可能对BMT结果不利，因此应在BMT前常规HLA表型分析中作为一个风险因素纳入。
