The impact of frequent HLA haplotypes in high linkage disequilibrium on donor search and clinical outcome after unrelated haematopoietic SCT

Bone Marrow Transplant. 2013 Apr;48(4):483-90. doi: 10.1038/bmt.2012.189. Epub 2012 Oct 15.

Abstract

The MHC region on chromosome 6 contains a large number of non-HLA genes next to the HLA genes. Matching for HLA in unrelated hematopoietic SCT (HSCT) does not necessarily mean that these non-HLA genes are also matched. We selected 348 Northwest European patients transplanted with an HLA-A-, -B-, -C-, -DRB1-, -DQB1-matched unrelated donor (MUD) between 1987 and 2008. Patients' haplotypes were identified via descend. We were unable to determine the haplotypes of the donor; therefore we used frequent haplotypes (FH) in high linkage disequilibrium (LD) as a proxy for haplotype matching. Presence of a FH in a patient positively affected the probability and speed of identifying a matched unrelated donor. Competing risk survival analysis showed that patients with one or two FH have a statistically significantly decreased probability of developing ≥ grade II acute GVDH (aGVHD) without increased risk of relapse compared to patients without FH (HR (95% CI): 0.53 (0.31-0.91)). This association was strongest for those FH with the highest LD between both HLA-A and -C or -B, and HLA-C or -B and -DRB1 (HR (95% CI): 0.49 (0.26-0.92)). These results extend evidence that non-HLA allele coding regions have a significant impact on development of ≥ grade II aGVHD. We conclude that there is more to successful HSCT than matching for HLA genes.

Publication types

  • Clinical Trial
  • Multicenter Study

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Disease-Free Survival
  • Donor Selection / methods*
  • Female
  • Graft vs Host Disease / etiology
  • Graft vs Host Disease / mortality*
  • Graft vs Host Disease / pathology
  • Graft vs Host Disease / prevention & control
  • HLA Antigens*
  • Haplotypes*
  • Hematopoietic Stem Cell Transplantation*
  • Histocompatibility Testing
  • Humans
  • Infant
  • Linkage Disequilibrium*
  • Male
  • Retrospective Studies
  • Risk Factors
  • Survival Rate
  • Transplantation, Homologous
  • Unrelated Donors*

Substances

  • HLA Antigens