Effect of matching of class I HLA alleles on clinical outcome after transplantation of hematopoietic stem cells from an unrelated donor

Takehiko Sasazuki, Takeo Juji, Yasuo Morishima, Naoko Kinukawa, Hidehiko Kashiwabara, Hidetoshi Inoko, Takato Yoshida, Akinori Kimura, Tatsuya Akaza, Nobuhiro Kamikawaji, Yoshihisa Kodera, Fumimaro Takaku, Yoshiaki Nose, Takashi Ono, Takeo Sakamaki, Shunichi Kato, Yuichi Akiyama, Shinichiro Okamoto, Hiroo Dohy, Mine HaradaShigetaka Asano

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    433 Scopus citations

    Abstract

    Background. The requirements with respect to HLA compatibility and the relative importance of matching for individual class I and class II HLA alleles in the transplantation of hematopoietic stem cells from unrelated donors have not yet been established. Methods. We performed retrospective DNA typing of alleles at 11 polymorphic loci of HLA genes in 440 recipients of hematopoietic stem cells from unrelated donors who were serologically identical with their respective recipients for HLA-A, B, and DR antigens. Of these recipients, 80 percent had leukemia; the rest had lymphoma, marrow failure, or a congenital disorder. Results. Multivariate analysis showed that incompatibility for HLA-A alleles and incompatibility for HLA-C alleles were independent risk factors for severe acute graft-versus-host disease (GVHD) (HLA-A, P=0.006; HLA-C, P=0.001). Mismatching of HLA-A, but not of HLA-C, alleles was an independent risk factor for death (P<0.001). Mismatching of HLA-C alleles was a significant risk factor for relapse of leukemia (P=0.035). HLA-B disparity was a significant risk factor for both GVHD and death in the univariate analysis, but not in the multivariate analysis. Disparities in class II HLA alleles of the DRB1, DQA1, DQB1, DPA1, and DPB1 loci were not identified as significant risk factors for acute GVHD or death in the multivariate analysis. Conclusions. Genomic typing of class I HLA alleles adds substantially to the success of transplantation of hematopoietic stem cells from unrelated donors, even if the donors are serologically identical to their recipients with respect to HLA-A, B, and DR antigens.

    Original languageEnglish (US)
    Pages (from-to)1177-1185
    Number of pages9
    JournalNew England Journal of Medicine
    Volume339
    Issue number17
    DOIs
    StatePublished - Oct 22 1998

    ASJC Scopus subject areas

    • Medicine(all)

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  • Cite this

    Sasazuki, T., Juji, T., Morishima, Y., Kinukawa, N., Kashiwabara, H., Inoko, H., Yoshida, T., Kimura, A., Akaza, T., Kamikawaji, N., Kodera, Y., Takaku, F., Nose, Y., Ono, T., Sakamaki, T., Kato, S., Akiyama, Y., Okamoto, S., Dohy, H., ... Asano, S. (1998). Effect of matching of class I HLA alleles on clinical outcome after transplantation of hematopoietic stem cells from an unrelated donor. New England Journal of Medicine, 339(17), 1177-1185. https://doi.org/10.1056/NEJM199810223391701