Roles of HLA-B, HLA-C and HLA-DPA1 incompatibilities in the outcome of unrelated stem-cell transplantation

In unrelated stem-cell transplantation, the value of matching at the HLA-A, -B and -DR loci between donor and recipient is well documented. The effect of HLA-C, DPB1 and DPA1 mismatches on transplantation outcome is unclear. In this study, 104 donor recipient-pairs, transplanted at Huddinge University Hospital between 1988 and 1999, were retrospectively HLA class I- and class II-typed by PCR-SSP. The samples were typed for HLA-A, -B and -C and HLA-DRB1, -DRB3, -DRB4, -DRB5, -DQA1, -DQB1, -DPB1 and -DPA1 with allele level resolution. Isolated HLA-B allele level mismatches were associated with an increased incidence of acute graft versus host disease grades II-IV and grades III-IV. HLA-C-mismatched, but killer cell immunoglobulin-like receptor (KIR) ligand motif-matched stem-cell grafts were significantly associated with improved survival rates and relapse-free survival (RFS). In patients receiving HLA-DPA1-mismatched stem cell grafts, reduced survival and shorter RFS were seen. These patients also had an increased frequency of relapses (64%vs 26%). We conclude that genomic HLA class I- and class II-typing may improve the outcome after unrelated stem-cell transplantation. The awareness of HLA class I- and II-mismatches in a recipient-donor pair makes it possible to give appropriate pre- and post-transplantation treatment.