High-resolution HLA matching in hematopoietic stem cell transplantation: a retrospective collaborative analysis

Blood. 2013 Oct 31;122(18):3220-9. doi: 10.1182/blood-2013-02-482547. Epub 2013 Sep 17.

Abstract

To validate current donor selection strategies based on previous international studies, we retrospectively analyzed 2646 transplantations performed for hematologic malignancies in 28 German transplant centers. Donors and recipients were high resolution typed for HLA-A, -B, -C, -DRB1, and -DQB1. The highest mortality in overall survival analysis was seen for HLA-A, -B, and DRB1 mismatches. HLA-DQB1 mismatched cases showed a trend toward higher mortality, mostly due to HLA-DQB1 antigen disparities. HLA incompatibilities at >1 locus showed additive detrimental effects. HLA mismatching had no significant effect on relapse incidence and primary graft failure. Graft source had no impact on survival end points, neither in univariate nor in multivariate analysis. Higher patient age, advanced disease, transplantations before 2004, patient C2C2 killer cell immunoglobulin-like receptor (KIR)-ligand phenotype, and unavailability of a national donor adversely influenced outcomes in multivariate analysis. Our study confirms the association of HLA-A, -B, -C, and -DRB1 incompatibilities with adverse outcome in hematopoietic stem cell transplantation (HSCT). The relevance of HLA-DQB1 disparities in single mismatched transplantations remains unclear. Similar hazard ratios for allele and antigen mismatches (possibly with an exception for HLA-DQB1) highlight the importance of allele level typing and matching in HSCT. The number of incompatibilities and their type significantly impact survival.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Female
  • Germany
  • Graft vs Host Disease / etiology
  • Graft vs Host Disease / genetics
  • Graft vs Host Disease / immunology
  • HLA-A Antigens / genetics
  • HLA-A Antigens / immunology
  • HLA-B Antigens / genetics
  • HLA-B Antigens / immunology
  • HLA-C Antigens / genetics
  • HLA-C Antigens / immunology
  • HLA-DQ beta-Chains / genetics
  • HLA-DQ beta-Chains / immunology
  • HLA-DRB1 Chains / genetics
  • HLA-DRB1 Chains / immunology
  • Hematologic Neoplasms / genetics
  • Hematologic Neoplasms / immunology
  • Hematologic Neoplasms / surgery*
  • Hematopoietic Stem Cell Transplantation / adverse effects
  • Hematopoietic Stem Cell Transplantation / methods*
  • Hematopoietic Stem Cell Transplantation / mortality
  • Histocompatibility / genetics
  • Histocompatibility / immunology
  • Histocompatibility Testing / methods*
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Retrospective Studies
  • Survival Analysis
  • Survival Rate
  • Tissue Donors*
  • Transplantation Immunology / immunology
  • Young Adult

Substances

  • HLA-A Antigens
  • HLA-B Antigens
  • HLA-C Antigens
  • HLA-DQ beta-Chains
  • HLA-DQB1 antigen
  • HLA-DRB1 Chains