Korean J Hematol.  2011 Mar;46(1):11-17. 10.5045/kjh.2011.46.1.11.

The impact of HLA matching on unrelated donor hematopoietic stem cell transplantation in Korean children

• Park M
• Koh KN
• Kim BE
• Im HJ
• Park KD
• Kang HJ
• Shin HY
• Ahn HS
• Yoo KH
• Sung KW
• Koo HH
• Park HJ
• Park BK
• Seo JJ

• KMID: 2252013
• DOI: http://doi.org/10.5045/kjh.2011.46.1.11

Abstract

BACKGROUND
The impact of HLA matching on outcomes of unrelated donor (URD) hematopoietic stem cell transplantation (HSCT) varies in different racial or ethnic groups. Since little is known about the impact of such matching on URD HSCT in Korean children, we analyzed this issue.
METHODS
We analyzed the outcomes of 142 patients who underwent URD HSCT at 4 Korean medical centers. All patient donor pairs were fully typed for HLA-A, -B, -C, and -DR alleles.
RESULTS
At a median follow-up of 22 months, 3-year survival rates for patients with 8, 7, and < or =6 matched alleles were 88.4%, 70.7%, and 53.6%, respectively. A single mismatch (Mm) at HLA-B or -C was associated with lower survival compared with that associated with 8 matched alleles. No significant differences were observed between single-allele and single-antigen Mms with respect to survival rate or acute graft-versus-host disease (aGVHD) incidence rates. HLA disparity had a greater impact on the survival of patients with high-risk malignancy than of those with low-risk malignancy. Among pairs with a single Mm, only locus A showed a significant association and higher risk of grade III-IV aGVHD compared to those in patients with 8 matched alleles.
CONCLUSION
Disparity in HLA class I, regardless of antigen or allele Mm, adversely affected both survival and grade III-IV aGVHD development. An increased number of HLA Mms was associated with a higher risk of post-transplantation complications. Further investigations using larger cohorts are required to confirm the effects of HLA mismatching on URD HSCT patient outcomes.

Keyword

URD HSCT; HLA; Korean children

MeSH Terms

Alleles
Child
Cohort Studies
Ethnic Groups
Follow-Up Studies
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Hematopoietic Stem Cells
HLA-A Antigens
HLA-B Antigens
Humans
Incidence
Survival Rate
Tissue Donors
Unrelated Donors
HLA-A Antigens
HLA-B Antigens

Figure

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  Fig. 1 Kaplan-Meier estimates of overall survival relative to HLA-matching status in all patients (A) and in patients with high risk (N=38) (B) and low risk (N=71) (C) hematologic malignancies.

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  Fig. 2 Cumulative 3-year incidence of transplant-related mortality in all patients (A) and in patients with high risk (N=38) (B) and low risk (N=71) (C) hematologic malignancies.

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