The impact of HLA-A,HLA-B,HLA-DRB1 high-resolution matching on the prognosis of hematopoietic stem cell transplantation from unrelated donors:a retrospective report / 白血病·淋巴瘤

Objective To assess the impact of HLA-A,HLA-B,HLA-DRB1 matching on the prognosis of hematopoietic stem cell transplantation from unrelated donors.Methods A total of 81 patients with hematological malignancies including leukemia,myelodysplastic syndrome(MDS)and lymphoma who underwent hematopoietic stem cell transplantation from unrelated donors from 2007 to 2012 in our department were included in this retrospective analysis.Patients were classified into HLA match group(n=53)and HLA mismatch group(n=28)according to the HLA high-resolution matching.The overall survival (OS),treatmentrelated mortality(TRM),relapse rate(RR),graft-versus-host disease(GVHD)incidence were analyzed.Results The 81 patients were analyzed with a median follow-up of 11.9 months(0.3 to 57.4 months).The OS (66.0％vs 46.4％,P=0.031)and TRM(17.0％vs 42.9％,P=0.017)were significantly different between the HLA match group and HLA mismatch group,while the RR had no significant difference(14.3％vs 32.1％,P=0.111).Multivariate analysis showed HLA matching was an independent prognostic factor of TRM,but not OS.There's no significant difference of aGVHD(22.9％vs 40.9％,P=0.122)and cGVHD (40.0％vs 46.7％,P=0.655)incidence between the two groups,but the incidence of severe aGVHD in HLA match group were much lower(4.2％vs 25.0％,P=0.005)than HLA mismatch group.Conclusion the high-resolution matching of HLA-A,-B,DRB1 affect OS,TRM and the incidence of severe aGVHD in unrelated hematopoietic stem cell transplantation,but not affect RR,the incidence of aGVHD and cGVHD.

Histocompatibility and Immunogenetics in Cord Blood Transplantation

This review of the immunogenetics of cord blood transplantation attempts to highlight the connections between classical studies and conclusions of the tissue transplantation field as a scholarly endeavor, exemplified by the work of Professor Hoecker, with the motivations and some recent and key results of clinical cord blood transplantation. The authors review the evolution of understanding of transplantation biology and find that the results of the application of cord blood stem cells to Transplantation Medicine are consistent with the careful experiments of the pioneers in the field, from the results of tumor and normal tissue transplants, histocompatibility immunogenetics, to cell and molecular biology. Recent results of the National Cord Blood Program of the New York Blood Center describe the functioning in cord blood transplantation of factors, well known in transplantation immunogenetics, like the Fl anti-parent effect and the tolerance-like status of donors produced by non-inherited maternal HLA antigens. Consideration of these factors in donor selection strategies can improve the prognosis of transplantation by characterizing "permissibility" in HLA-incompatible transplantation thereby increasing the probability of survival and reducing the likelihood of leukemic relapse.

Analysis of Relationship between Positive T Lymphocytotoxic and/or B Lympocytotoxic Cross- Match and Acute Rejection in Adult-to-Adult Living Donor Liver Transplantation / 대한이식학회지

PURPOSE: The influences of lymphocytotoxic cross-match on survival or acute rejection after adult-to-adult living donor liver transplantation (LDLT) have not been fully studied and there have been some arguments about its influence. In this study, we retrospectively investigated the influence of lymphocytotoxic cross-match in LDLT and assessed the survival of recipients and the incidence of acute rejection. METHODS: 142 adult-to-adult LDLT were performed in adult patients in our institution between January 2003 and December 2003. Among them, HLA cross-matching tests were done in 78 cases and we analyzed their data of HLA cross-match. Recipients were 62 males and 16 females, and their mean age was 50 7 years. Most of the donors were genetically related to the recipients. Lymphocyototxic cross-match was performed according to the standard National Institutes of Health technique. The cross-match test was interpreted as positive when more than 20% of the donor lymphocytes were killed by the recipient serum, Acute cellular rejection was defined as a biopsy-proven episode and graded according to the Banff schema. RESULTS: The results of positive T and/or B cell cross-match observed in only 5 cases (6.4%). In this series, there were episodes of acute rejection in 10 recipients (13.6%) after 1~9 months, but all of 10 had revealed negative results of T and B cell cross-match. Additionally, the results of positive T and/or B cell cross-match did not change the incidence of acute rejection. All of the recipients undergone acute rejection were treated successfully using steroid bolus therapy and survive to date. CONCLUSION: According to our preliminary results, positive T and/or B cell cross-match did not give significant impact upon either the incidence of acute rejection or the survival rate in our series with 13% incidence of acute rejection and 5% mortality.