Submitted June 21, 2006
Accepted September 20, 2006
Beyond HLA: the significance of genomic variation for
allogeneic hematopoietic stem cell transplantation
Ann Mullally and Jerome Ritz*
Department of Medical Oncology, Dana-Farber Cancer Institute
* Corresponding author; email: jerome_ritz{at}dfci.harvard.edu.
The last two years have seen much excitement in the field of genetics with the identification of a formerly unappreciated level of "structural variation" within the normal human genome. Genetic structural variants include deletions, duplications and inversions in addition to the recently discovered, copy number variants (CNVs). Single nucleotide polymorphisms (SNPs) are the most extensively evaluated variant within the genome to date. Combining our knowledge from these studies with our rapidly accumulating understanding of structural variants, it is apparent that the extent of genetic dissimilarity between any two individuals is considerable and much greater than that which was previously recognized. Clearly, this more diverse view of the genome has significant implications for allogeneic hematopoietic stem cell transplantation (HSCT), not least in the generation of transplant antigens but also in terms of individual susceptibility to transplant related toxicities. With advances in DNA sequencing technology we now have the capacity to perform genome-wide analysis in a high throughput fashion, permitting a detailed genetic analysis of patient and donor prior to transplantation. Understanding the significance of this additional genetic information and applying it in a clinically meaningful way will be one of the challenges faced by transplant clinicians in the future.
