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Blood, 1 October 2007, Vol. 110, No. 7, pp. 2235-2241.
Prepublished online as a Blood First Edition Paper on June 6, 2007; DOI 10.1182/blood-2007-02-072405.


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PLENARY PAPER

High-risk HLA allele mismatch combinations responsible for severe acute graft-versus-host disease and implication for its molecular mechanism

Takakazu Kawase1, Yasuo Morishima2, Keitaro Matsuo3, Koichi Kashiwase4, Hidetoshi Inoko5, Hiroh Saji6, Shunichi Kato7, Takeo Juji8, Yoshihisa Kodera9, Takehiko Sasazuki10, for The Japan Marrow Donor Program

1 Division of Immunology, Aichi Cancer Center, Nagoya; 2 Department of Hematology and Cell Therapy, Aichi Cancer Center, Nagoya; 3 Division of Epidemiology and Prevention, Aichi Cancer Center, Nagoya; 4 Japanese Red Cross Tokyo Metropolitan Blood Center, Tokyo; 5 Division of Molecular Science, Tokai University School of Medicine, Isehara; 6 Human Leukocyte Antigen (HLA) Laboratory, Nonprofit Organization (NPO), Kyoto; 7 Department of Cell Transplantation and Regenerative Medicine, Tokai University School of Medicine, Isehara; 8 Japanese Red Cross Central Blood Institute, Tokyo; 9 Japanese Red Cross Nagoya First Hospital, Nagoya; 10 International Medical Center of Japan, Tokyo, Japan

In allogenic hematopoietic stem-cell transplantation, an effect of HLA locus mismatch in allele level on clinical outcome has been clarified. However, the effect of each HLA allele mismatch combination is little known, and its molecular mechanism to induce acute graft-versus-host disease (aGVHD) remains to be elucidated. A total of 5210 donor-patient pairs who underwent transplantation through Japan Marrow Donor Program were analyzed. All HLA-A, -B, -C, -DRB1, -DQB1, and -DPB1 alleles were retrospectively typed in all pairs. The impacts of the HLA allele mismatch combinations and amino acid substitution positions in 6 HLA loci on severe aGVHD were analyzed. A total of 15 significant high-risk HLA allele mismatch combinations and 1 HLA-DRB1-DQB1 linked mismatch combinations (high-risk mismatch) for severe aGVHD were identified, and the number of high-risk mismatches was highly associated with the occurrence of severe aGVHD regardless of the presence of mismatch combinations other than high-risk mismatch. Furthermore, 6 specific amino acid substitution positions in HLA class I were identified as those responsible for severe aGVHD. These findings provide evidence to elucidate the mechanism of aGVHD on the basis of HLA molecule. Furthermore, the identification of high-risk mismatch, that is, nonpermissive mismatch, would be beneficial for the selection of a suitable donor.


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