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Blood, 15 December 2007, Vol. 110, No. 13, pp. 4576-4583.
Prepublished online as a Blood First Edition Paper on September 4, 2007; DOI 10.1182/blood-2007-06-097386.
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Submitted June 25, 2007
Accepted August 24, 2007
High-resolution donor-recipient HLA matching contributes to the success of unrelated donor marrow transplantation
Stephanie J Lee*, John Klein, Michael Haagenson, Lee Ann Baxter-Lowe, Dennis L. Confer, Mary Eapen, Marcelo Fernandez-Vina, Neal Flomenberg, Mary Horowitz, Carolyn K Hurley, Harriet Noreen, Machteld Oudshoorn, Effie Petersdorf, Michelle Setterholm, Stephen Spellman, Daniel Weisdorf, Thomas M. Williams, and Claudio Anasetti
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
Center for International Blood & Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, United States
Center for International Blood & Marrow Transplant Research, Minneapolis, MN, United States
Department of Surgery, University of California, San Francisco, CA, United States
National Marrow Donor Program, Minneapolis, MN, United States
Department of Laboratory Medicine, M.D. Anderson Cancer Center, Houston, TX, United States
Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, United States
Department of Oncology, Georgetown University Medical Center, Washington, DC, United States
Immunology/Histocompatibility Laboratory, University of Minnesota Medical Center, Fairview, MN, United States
Europdonor Foundation, Leiden, Netherlands
BMT Program, University of Minnesota, Minneapolis, MN, United States
Department of Pathology, University of New Mexico, Albuquerque, NM, United States
H. Lee Moffitt Cancer Center, Tampa, FL, United States
* Corresponding author; email: sjlee{at}fhcrc.org.
The relative importance of various HLA loci and the resolution level at which they are matched has not been fully defined for unrelated donor transplantation. To address this question, National Marrow Donor Program® data from 3857 United States transplantations performed from 1988-2003 were analyzed. Patient-donor pairs were fully typed for HLA-A, B, C, DRB1, DQB1, DQA1, DPB1, and DPA1 alleles. High resolution DNA matching for HLA-A, B, C, and DRB1 [8/8 match] was the minimum level of matching associated with the highest survival. A single mismatch detected by low or high resolution DNA testing at HLA-A, B, C or DRB1 [7/8 match] was associated with higher mortality (relative risk 1.25, 95% CI 1.13-1.38, p<0.0001) and 1-yr survival of 43% compared to 52% for 8/8 matched pairs. Single mismatches at HLA-B or HLA-C appear better tolerated than mismatches at HLA-A or HLA-DRB1. Mismatching at two or more loci compounded the risk. Mismatching at HLA-DP or DQ loci and donor factors other than HLA type were not associated with survival. In multivariate modeling, patient age, race, disease stage and CMV status were as predictive of survival as donor HLA matching. High resolution DNA matching for HLA-A, B, C, and DRB1 alleles is associated with higher rates of survival.

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