[HLA and bone marrow transplantation (BMT) (author's transl)]

Area of Science:

• Immunogenetics
• Transplantation immunology

Context:

• Bone marrow transplantation (BMT) is a critical treatment for various hematologic and immunologic disorders.
• Donor-recipient compatibility, specifically human leukocyte antigen (HLA) matching, is a key determinant of BMT success.
• Previous studies have indicated varying survival rates based on HLA matching and disease type.

Purpose:

• To analyze the correlation between HLA-type matching and patient survival rates following bone marrow transplantation (BMT).
• To compare survival outcomes across different diseases (acute leukemia, severe combined immunodeficiency disease (SCID), severe aplastic anemia) based on donor HLA compatibility.
• To evaluate the impact of HLA-D and HLA-phenotypical identity, as well as related vs. unrelated donors, on BMT success.

Summary:

• BMT survival is directly correlated with donor HLA-type. Genotypically identical sibling donors yield higher survival rates (56% in acute leukemia, 55% in SCID, 67-83% in aplastic anemia).
• HLA-D identical related or unrelated donors show lower survival in SCID (37%), acute leukemia (18%), and aplastic anemia (11%).
• Transplantation with HLA-phenotypical and MLC identical unrelated donors, or HLA-mismatched marrow, resulted in patient death. Survival is also influenced by clinical factors like pre-BMT transfusions and disease remission status.

Impact:

• Highlights the critical importance of precise HLA matching for successful BMT outcomes.
• Provides data to guide donor selection strategies, emphasizing the superiority of HLA-identical siblings.
• Underscores the need to consider clinical context, such as disease status and transfusion history, in predicting BMT success.