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HLA mismatching within or outside of cross reactive groups (CREG) is associated with similar outcomes after unrelated hematopoietic stem cell transplant.

Wade JA, Hurley CK, Takemoto SK, Thompson J, Davies SM, Fuller TC, Rodey G, Confer DL, Noreen H, Haagenson M, Kan F, Klein J, Eapen M, Spellman S, Kollman C

Department of Surgery, University of Toronto, Toronto, Canada.

The National Marrow Donor Program(R) maintains a registry of volunteer donors for patients in need of a hematopoietic stem cell transplant. Strategies for selecting a partially HLA-mismatched donor vary when a full match cannot be identified. Some transplant centers limit the selection of mismatched donors to those sharing mismatched antigens within HLA-A, -B cross reactive groups (CREG). To assess whether an HLA mismatch within a CREG group ("minor") may result in better outcome than a mismatch outside CREG groups ("major"), we analyzed validated outcomes data from 2709 bone marrow and peripheral blood stem cell transplants. 396 pairs (15%) were HLA-DRB1 allele matched but had an antigen-level mismatch at HLA-A or -B. Univariate and multivariate analyses of engraftment, graft-versus-host disease and survival showed that outcome is not significantly different between "minor" and "major" mismatches (p=0.47 from the log-rank test for Kaplan-Meier survival). However, HLA-A, -B, -DRB1 allele matched cases had significantly better outcome than mismatched cases (p<0.0001). For patients without an HLA match, the selection of a CREG compatible donor as tested does not improve outcome.

Published 4 January 2007 in Blood.
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