Marrow Transplantation from Related Donors Other Than HLA-Identical Siblings

Abstract

Marrow transplantation has generally been limited to patients with a sibling who is genotypically identical for HLA. In a study of the acceptable limits of HLA incompatibility, 105 consecutive patients with hematologic cancers who received marrow grafts from haploidentical donors (study group) were compared with 728 similar patients concurrently receiving grafts from HLA genotypically identical siblings (control group). The unshared haplotypes differed variably: 12 were phenotypically but not genotypically identical for HLA-A, HLA-B, and HLA-D; 63 differed at one locus (A, B, or D); 24 at two loci; and 6 at three. A higher proportion of study patients had delayed engraftment, granulocytopenia, or graft rejection. Acute graft versus host disease occurred earlier and with greater frequency in study patients. The risk of the disease did not correlate with disparity for Class I (A or B) versus Class II (D-region) loci. Thus, incompatibility for HLA has an important effect on the course after clinical marrow transplantation. In spite of these complications, there was no statistically significant difference in the survival of the study patients and control patients who received their transplants during remission.

Acute graft versus host disease due to T lymphocytes recognizing a single HLA-DPB1*0501 mismatch.

“…Two main risk factors are linked to the occurrence of aGVHD: the T cell content of the graft and the HLA disparities between donor and recipient. With respect to HLA disparities, the increased risk of aGVHD linked to HLA-A, -B, -DR mismatching between donor and recipient is well established (3)(4)(5)(6)(7)(8), in contrast HLA-DP incompatibility does not seem to be a risk factor for aGVHD (for review see references 9 and 10). Accordingly, it was proposed that HLA-DP determinants might not function as transplantation antigens in the same way as HLA-A, -B, or -DR (10).…”

First Successful Haploidentical Stem Cell Transplantation in Romania

“…The patients enrolled in this study died from pulmonary edema, fever, fluid retention or kidney failure. This syndrome is known as engraftment syndrome, a diagnosis confirmed in another study by Beatty et al [14].…”

Having a sibling as donor: Patients' experiences immediately before allogeneic hematopoietic stem cell transplantation

“…The search for a donor, therefore, starts among the patient's biological siblings, where there is a 25 percent chance of each sibling being HLA-matched. At the beginning of the HSCT era it was predominantly HLA-matched siblings who were used as donors (Beatty et al, 1985;Gluckman, 2012). However, since it is not always possible to find a suitable donor among siblings, registries of unrelated donors have been established.…”