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Histocompatibility and Donor Selection Issues

Consideration of noninherited maternal Ags as permissible HLA mismatches in cord blood donor selection

Abstract

In cord blood (CB) transplantation, virtual 6/6 HLA matches, whereby the donor–recipient mismatch is identical to the CB noninherited maternal Ag (NIMA), have similar outcomes to inherited 6/6 matches. In the UK-British Bone Marrow Registry (BBMR), 4707 of the total 21 020 CB donors have the NIMA defined. Retrospective searches of these donors, for 1–3 NIMA matches, identified a virtual 6/6 match for 31.4% of 274 European Caucasoid (EC) and 25.4% of 67 other ethnicity (OE) patients. Patients weighing 50 kg were also evaluated for a single graft with adequate cell dose. In 125 EC patients, 6/6 HLA matches were identified for 24.0% and virtual 6/6 matches were identified for a further 21.6%. The remaining EC patients had a 5/6 (30.4%) or a 4/6 (22.4%) match. In OE patients, 6/6 HLA matches were identified for 9.3% and virtual 6/6 matches were identified for a further 18.7%. The remaining OE patients had a 5/6 (30.2%) or a 4/6 (37.2%) match. Searches were also performed using the 26 735 Bone Marrow Donors Worldwide CB with defined NIMA and yielded comparable increases. Considering NIMA as permissible mismatches in donor selection therefore increased the availability of a 6/6 match in this cohort.

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Acknowledgements

We thank all mothers for donating their CB to the NHS-Cord Blood Bank; Professor J van Rood for providing expertise and advice for the manuscript; BMDW for developing the NIMA Match Program; the Histocompatibility and Immunogenetics Laboratory at NHSBT Colindale for performing the HLA typing of maternal samples and A Niewiarowska for helpful discussions on the presentation of results. This work was funded by the British Bone Marrow Donor Appeal, administered through an NHSBT Trust Fund.

Author contributions

LP, CB and CVN contributed to the conception and design of the study; LP performed the research, interpreted the data and drafted the manuscript; CB and CVN supervised the study and reviewed the manuscript. AM developed and validated the BMDW NIMA Match Program. GP manages the banking and release of NHS-CBB CBUs and LY administers and provides the CBU donor files for submission to BMDW. All authors read and approved the final manuscript.

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Correspondence to C V Navarrete.

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The authors declare no conflict of interest.

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Supplementary Information accompanies this paper on Bone Marrow Transplantation website

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Powley, L., Brown, C., Melis, A. et al. Consideration of noninherited maternal Ags as permissible HLA mismatches in cord blood donor selection. Bone Marrow Transplant 51, 675–679 (2016). https://doi.org/10.1038/bmt.2015.344

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