Vol 1, No 1 (2010)
Review paper
Published online: 2010-02-04

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The role of HLA disparity in hematopoietic stem cells transplantation

Jacek Nowak
Hematologia 2010;1(1):49-58.

Abstract

Human leukocyte antigen (HLA) disparity between hematopoietic stem cell (HSC) donor and recipient triggers T-cell and NK-cell allorecognition, and induces the graft-versus-host disease (GvHD), graft-versus-leukemia (GvL) effect and/or may cause an engraftment failure. This review shows the scope of human genomic variation, the methods of HLA typing, principles of the novel HLA nomenclature effective as from 2010 and interpretation of high-resolution HLA results. It describes the main subsets of related and unrelated HSC donors and sum up the main aspects of HLA disparity and their effect on the outcome of the patients after allogeneic HSC transplantation. The HLA match between HSC donor and recipient is crucial, but for many patients a perfectly matched donor can be unavailable. The HSC transplantation from the alternative mismatched donor with one allele/antigen mismatch (9/10) can be as beneficial as HSC transplantation from fully matched donor (10/10), especially in younger patients. For the remaining patients, the donors with permissive mismatches may be the option. The permissiveness depends not only on the potential adverse effect of the HLA mismatches, but also on the urgency of the transplantation, desirable GvL effect, and potential efficacy of the alternative therapy available for the patient.

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Hematology in Clinical Practice