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Unrelated Donor Identification

Bone marrow transplantation with unrelated donors: what is the probability of identifying an HLA-A/B/Cw/DRB1/B3/B5/DQB1-matched donor?

Bone Marrow Transplantation volume 26, pages 437–441 (2000)Cite this article

Abstract

Patients transplanted with marrow from an HLA-ABDR serologically matched unrelated donor suffer from more post-transplant complications than those who are transplanted with marrow from an HLA-identical sibling. This is most likely due to either HLA-ABDR incompatibilities not resolved by standard techniques and/or HLA polymorphisms not tested for by routine tissue typing (HLA-Cw,-DQ). By resolving these incompatibilities by molecular techniques combined with the in vitro cytotoxic T lymphocyte precursor frequency (CTLpf) test, we have shown that a high degree of HLA compatibility is associated with increased patient survival. However, higher requirements for HLA matching decrease the number of available donors. We have estimated the probability of finding an HLA-A/B/Cw/DRB1/DRB3/DRB5/DQB1 compatible donor based on 104 consecutive unrelated bone marrow donor searches initiated between January 1995 and December 1997, with December 1998 as the endpoint. For 96 patients (92.3%), one or more ABDR-identical donors were listed in the Bone Marrow Donor Worldwide Registry (BMDW). After contacting the registries, we obtained at least one (mean, 5.36; range, 1–20; total, 461) blood sample for 86 patients. A highly compatible donor was identified for 33/86 patients (38.4%), after testing an average number of 4.5 donors/patients (range, 1–13). However, by accepting an HLA-DRB3 or -DQB1 or -Cw incompatibility, this number would be as high as 68.6%. Approximately half of the patients (n = 40) for whom a search had been initiated have been transplanted: 22 patients with a perfectly matched donor, 15 patients with an HLA-DRB3 or -DQB1 or -Cw mismatch and three with other mismatches. The average time needed to identify the most compatible donor was 4 months. Extremely long searches seemed to be less useful, because after testing the first seven, a more compatible donor was seldom found. These results show that even when requirements for compatibility are high, the chances of finding a donor remain considerable. Bone Marrow Transplantation (2000) 26, 437–441.

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Acknowledgements

We would like to acknowledge the collaboration of Mrs G Baillif and Mrs I Wenger from the Swiss Bone Marrow Donor Registry. We also thank the technical staff of the LNRH for tissue typing. This work was supported by the Swiss National Science Foundation (grant 31–45899.95 and 31–53774.98) and by the Dr Henri Dubois-Ferrière-Dinu Lipatti Foundation.

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Authors and Affiliations

  1. Transplantation Immunology Unit, National Reference Laboratory for Histocompatibility, University Hospital, Geneva, Switzerland

    J-M Tiercy, M Bujan-Lose & E Roosnek

  2. Department of Haematology, University Hospital, Geneva, Switzerland

    B Chapuis

  3. Department of Haematology, University Hospital, Basel, Switzerland

    A Gratwohl

  4. Klinik im Park, Zürich, Switzerland

    J Gmür

  5. Kinderspital, Universitäts-Kinderklinik, Zürich, Switzerland

    R Seger

  6. Swiss Bone Marrow Donor Registry, Bern, Switzerland

    M Kern & A Morell

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  1. J-M Tiercy
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Tiercy, JM., Bujan-Lose, M., Chapuis, B. et al. Bone marrow transplantation with unrelated donors: what is the probability of identifying an HLA-A/B/Cw/DRB1/B3/B5/DQB1-matched donor?. Bone Marrow Transplant 26, 437–441 (2000). https://doi.org/10.1038/sj.bmt.1702529

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