Major-Histocompatibility-Complex Class I Alleles and Antigens in Hematopoietic-Cell Transplantation
Top Cited Papers
Open Access
- 20 December 2001
- journal article
- research article
- Published by Massachusetts Medical Society in New England Journal of Medicine
- Vol. 345 (25) , 1794-1800
- https://doi.org/10.1056/nejmoa011826
Abstract
Successful engraftment of hematopoietic stem cells from unrelated donors is influenced by disparities between the donor and recipient for HLA-A, B, and C alleles. Disparities between HLA sequence polymorphisms that are serologically detectable are termed antigen mismatches, whereas those that can be identified only by DNA-based typing methods are termed allele mismatches. Whether both kinds of polymorphisms are important in transplantation is not known. We tested the hypothesis that allele mismatches that are detectable only at the DNA level are less immunogenic than those that are serologically detectable and thereby are associated with a lower risk of graft failure after hematopoietic-cell transplantation. We used DNA sequencing to define the HLA-A, B, and C alleles in 471 patients who received bone marrow from unrelated donors for the treatment of chronic myeloid leukemia after myeloablative conditioning therapy. The odds ratios for graft failure were determined for recipients of transplants from donors with a single class I allele mismatch, a single class I antigen mismatch, or two or more class I mismatches, as compared with those with no mismatch. A single HLA allele mismatch did not increase the risk of graft failure, whereas a single antigen mismatch significantly increased the risk. The risk was also increased if the recipient was HLA homozygous at the mismatched class I locus or if the donor had two or more class I mismatches. HLA class I antigen mismatches that are serologically detectable confer an enhanced risk of graft failure after hematopoietic-cell transplantation. Transplants from donors with a single class I allele mismatch that is not serologically detectable may be used without an increased risk of graft failure.Keywords
This publication has 29 references indexed in Scilit:
- Nomenclature for factors of the HLA system, 2000Tissue Antigens, 2001
- Bone Marrow Transplants from Unrelated Donors for Patients with Chronic Myeloid LeukemiaNew England Journal of Medicine, 1998
- Structure of the complex between human T-cell receptor, viral peptide and HLA-A2Nature, 1996
- Peptides Naturally Presented by MHC Class I MoleculesAnnual Review of Immunology, 1993
- MARROW TRANSPLANTATION FROM HLA-MATCHED UNRELATED DONORS FOR TREATMENT OF HEMATOLOGIC MALIGNANCIESTransplantation, 1991
- Effect of HLA Compatibility on Engraftment of Bone Marrow Transplants in Patients with Leukemia or LymphomaNew England Journal of Medicine, 1989
- The foreign antigen binding site and T cell recognition regions of class I histocompatibility antigensNature, 1987
- Structure of the human class I histocompatibility antigen, HLA-A2Nature, 1987
- LEUKOCYTE GROUPING. A METHOD AND ITS APPLICATION*Journal of Clinical Investigation, 1963
- Nonparametric Estimation from Incomplete ObservationsJournal of the American Statistical Association, 1958