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Donor Selection

Impact of high-resolution matching in allogeneic unrelated donor stem cell transplantation in Switzerland

Abstract

It is currently unknown what degree of human leukocyte antigen (HLA)-mismatching is acceptable in unrelated donor hematopoietic stem cell transplantation (UD-HSCT). Mismatches at some loci may be more permissive than others. We have analyzed the effect of high-resolution HLA-matching on outcome of all 214 consecutive recipients of UD-HSCT carried out in Switzerland. All typing was by the Swiss reference laboratory. Donor–recipient pairs were HLA-10/10 matched (n=130) or mismatched for either HLA-A/-B/-DRB1/multiple loci (n=33; (HLA-A/-B=10); (-DRB1=8); (multiple=15)); HLA-C (n=29) or HLA-DQ/-DRB3 (n=22; (DQ=16); (-DRB1=6)). The median follow-up was 32 months. Survival probabilities (±95% confidence interval) at 3 years were 57 (±10)% for recipients of HLA 10/10-matched transplants, 53 (±22)% for recipients of HLA-DQ/-DRB3-mismatched transplants, 44 (±20)% for recipients of HLA-C-mismatched transplants and 0% for recipients of transplants mismatched at HLA-A/-B/-DRB1/multiple loci (P<0.0001). In multivariate analyses, HLA compatibility was the variable most significantly associated with survival and treatment-related mortality. We found important differences in survival in recipients of UD-HSCT with best results for transplants from 10/10 matched donors. Single mismatches at HLA-DQ/-DRB3 were well tolerated, mismatches at HLA-C had intermediate results and mismatches at HLA-A/-B/-DRB1/multiple loci resulted in poor survival.

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Acknowledgements

We would like to acknowledge the contribution of the medical and nursing staff of the four BMT units. We are grateful to the technicians of the different stem cell laboratories and those of the Swiss National Reference Laboratory for Histocompatibility (LNRH) for their excellent technical contribution. We also thank Jean Ringrose for her assistance with writing the manuscript. We acknowledge the support of the Swiss National Science Foundation (Grant No. 3100-068260).

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Correspondence to Y Chalandon.

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Supplementary Information accompanies the paper on Bone Marrow Transplantation website (http://www.nature.com/bmt).

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Chalandon, Y., Tiercy, JM., Schanz, U. et al. Impact of high-resolution matching in allogeneic unrelated donor stem cell transplantation in Switzerland. Bone Marrow Transplant 37, 909–916 (2006). https://doi.org/10.1038/sj.bmt.1705353

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