Effect of HLA class I or class II incompatibility in pediatric marrow transplantation from unrelated and related donors

Hum Immunol. 2001 Apr;62(4):399-407. doi: 10.1016/s0198-8859(01)00220-8.


The degree of histoincompatibility that can be tolerated, and the relative importance of matching at individual HLA class I and class II locus in bone marrow transplantation (BMT) has not been established. We hypothesized that matching for HLA-DR may not be more important than matching for HLA-A or HLA-B in selection of a donor for successful BMT. We retrospectively analyzed the outcomes of 248 consecutive pediatric patients who received allogeneic BMT from related donors (RD, n = 119) or unrelated donors (URD, n = 129). HLA-A and HLA-B were serologically matched, and HLA-DRB1 were identical by DNA typing in 69% of donor-recipient pairs. Most patients (89%) had hematologic malignancies; the rest had aplastic anemia or a congenital disorder. One HLA-A antigen mismatch was associated with a decrease in survival (p = 0.003) and a delay in granulocyte engraftment (p = 0.02) in recipients of RD marrow; as well as a decrease in survival (p = 0.02) and the development of severe acute graft-versus-host disease (GVHD) (p = 0.03) in recipients of URD marrow. One HLA-B antigen mismatch was associated with a decrease in the survival (p = 0.05) and the development of severe GVHD (p = 0.0007) in recipients of RD marrow. One HLA-DRB1 allele mismatch was associated only with a decrease in the survival (p = 0.0003) of recipients of RD marrow. Results of this study suggest that disparity in HLA-A and HLA-B antigens may not be better tolerated than disparity in HLA-DR allele in allogeneic BMT. Further studies are warranted to confirm our results.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Blood Group Incompatibility / immunology*
  • Bone Marrow Transplantation / immunology*
  • Child
  • Child, Preschool
  • Female
  • Graft vs Host Disease / immunology
  • HLA-A Antigens / immunology*
  • HLA-B Antigens / immunology*
  • HLA-DR Antigens / immunology*
  • HLA-DRB1 Chains
  • Humans
  • Infant
  • Male
  • Pediatrics
  • Recurrence
  • Retrospective Studies
  • Survivors
  • Tissue Donors
  • Treatment Outcome


  • HLA-A Antigens
  • HLA-B Antigens
  • HLA-DR Antigens
  • HLA-DRB1 Chains