Importance of HLA and Haploidentical Donor Selection

Fuchs EJ, McCurdy SR, Solomon SR, et al. HLA Informs Risk Predictions After Haploidentical Stem Cell Transplantation with Post-Transplantation Cyclophosphamide. Blood. 2021; (doi: 10.1182/blood.2021013443).

Human leukocyte antigen (HLA) factors contribute significantly to successful haploidentical transplantation with post-transplantation cyclophosphamide (PTCy) and should be incorporated into the selection of haploidentical donors, new research shows. In all, 1,434 acute leukemia or myelodysplastic syndrome patients at the Center for International Blood and Marrow Transplant Research were studied to understand how HLA mismatching influences post-transplant graft-versus-host disease (GVHD), disease recurrence, and survival. Disease recurrence was less likely in the presence of HLA-DRB1 mismatches, and disease-free survival improved with HLA-DQB1-matching. Overall survival also improved with HLA-B leader matching and HLA-DPB1 TCE-non-permissive mismatching. Chronic GVHD risk declined with HLA-C, while transplant-related mortality was associated with HLA-C expression. Disease-free survival was predicted by matching status at the HLA-B leader and HLA-DRB1, -DQB1, and -DPB1. Patient and donor cytomegalovirus serostatus, patient age, and co-morbidity index also predicted disease-free survival. The researchers devised an online tool to calculate disease-free survival based on HLA factors in selecting the best haploidentical related donor.

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