Adding HLA-C Matching Cuts Cord Blood Transplant Death

HLA-C matching lowers transplant-related mortality after umbilical-cord blood transplantation

FRIDAY, Oct. 7 (HealthDay News) -- Umbilical-cord blood transplantation-related deaths can be reduced by matching donor units with recipients at the human leukocyte antigen (HLA)-C locus in addition to the HLA-A, B, and DRB1 loci, even if there is a single mismatch at these loci, according to a study published online Oct. 7 in The Lancet Oncology.

Mary Eapen, M.R.C.P.I., from the Medical College of Wisconsin in Milwaukee, and colleagues assessed the relative importance of additional donor-recipient matching at HLA-C for unrelated umbilical-cord blood transplantation for leukemia and myelodysplastic syndrome, in 803 patients (69 percent age ≤16 years). Transplant-related mortality was the primary end point. Molecular techniques with a minimum of intermediate resolution for HLA-A, B, and C, and at the allele-level for DRB1 were used for HLA typing.

The investigators found that the transplant-related mortality risk was higher after transplantations matched at HLA-A, B, and DRBI but mismatched at HLA-C, than transplantations matched at HLA-A, B, C, and DRB1 (hazard ratio [HR], 3.97). Transplantations with a single mismatch at HLA-A, B, or DRB1 and mismatched at HLA-C also had a higher mortality risk compared to transplantations with a single mismatch at HLA-A, B, or DRB1 but matched at HLA-C (HR, 1.70). The overall effect of HLA disparity on transplant-related mortality revealed that units mismatched at two, three, or four loci had a significantly higher risk of mortality compared with matched units.

"Mismatching at HLA-C is an independent risk factor for transplant-related mortality when transplants are matched at HLA-A, B, or DRB1, or mismatched at a single HLA-A, B, or DRB1 locus," the authors write.

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