Acceptable HLA-mismatching in unrelated donor bone marrow transplantation for patients with acquired severe aplastic anemia

• Published in: Blood Vol. 118; no. 11; pp. 3186 - 3190
• Main Authors: Yagasaki, Hiroshi, Kojima, Seiji, Yabe, Hiromasa, Kato, Koji, Kigasawa, Hisato, Sakamaki, Hisashi, Tsuchida, Masahiro, Kato, Shunichi, Kawase, Takakazu, Morishima, Yasuo, Kodera, Yoshihisa
• Format: Journal Article
• Language: English
• Published: Washington, DC Elsevier Inc 15.09.2011; Americain Society of Hematology
• Subjects: Adolescent; Adult; Anemia, Aplastic - immunology; Anemia, Aplastic - mortality; Anemia, Aplastic - therapy; Biological and medical sciences; Bone Marrow Transplantation - immunology; Bone Marrow Transplantation - mortality; Bone Marrow Transplantation - standards; Child; Child, Preschool; Female; Hematologic and hematopoietic diseases; Histocompatibility Testing - standards; HLA Antigens - immunology; HLA-DP beta-Chains - genetics; HLA-DP beta-Chains - immunology; Humans; Infant; Infant, Newborn; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Middle Aged; Molecular Typing; Other diseases. Hematologic involvement in other diseases; Severity of Illness Index; Sibling Relations; Tissue Donors; Young Adult; Human; HLA-System; Hematology; Bone marrow failure; Acquired; Allogeneic bone marrow transplantation; Major histocompatibility system; Aplastic anemia; Hemopathy; Mismatching
• ISSN: 0006-4971; 1528-0020; 1528-0020
• DOI: 10.1182/blood-2011-04-349316

We retrospectively analyzed the effect of HLA mismatching (HLA-A, -B, -C, -DRB1, -DQB1) with molecular typing on transplantation outcome for 301 patients with acquired severe aplastic anemia (SAA) who received an unrelated BM transplant through the Japan Marrow Donor Program. Additional effect of HLA-DPB1 mismatching was analyzed for 10 of 10 or 9 of 10 HLA allele-matched pairs (n = 169). Of the 301 recipient/donor pairs, 101 (33.6%) were completely matched at 10 of 10 alleles, 69 (23%) were mismatched at 1 allele, and 131 (43.5%) were mismatched at ≥ 2 alleles. Subjects were classified into 5 subgroups: complete match group (group I); single-allele mismatch group (groups II and III); multiple alleles restricted to HLA-C, -DRB1, and -DQB1 mismatch group (group IV); and others (group V). Multivariate analysis indicated that only HLA disparity of group V was a significant risk factor for poor survival and grade II-IV acute GVHD. HLA-DPB1 mismatching was not associated with any clinical outcome. We recommend the use of an HLA 10 of 10 allele-matched unrelated donor. However, if such a donor is not available, any single-allele or multiple-allele (HLA-C, -DRB1, -DQB1) mismatched donor is acceptable as an unrelated donor for patients with severe aplastic anemia.