Neha Katanguri

Pd. 3
HLA-matching donors
Source:
Morishima, Y., Kashiwase, K., Matsuo, K., Azuma, F., Morishima, S., Onizuka, M., . . .
Sasazuki, T. (2015, February 12). Biological significance of HLA locus matching in unrelated
donor bone marrow transplantation. Retrieved March 11, 2018, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4326776/

This article describes how obtaining an HLA matched- unrelated donor during a bone
marrow transplantation may be a better choice than other donor options. There are 6 different
types of alleles/ donor types used in this case study. They are HLA-A, -B, -C, -DRB1, -DQB1,
and -DPB1 alleles. Some of these benefit the patient by helping reduce mortality and leukemic
relapse, but some can be harmful and cause GVHD. As mentioned in the article, to test the effect
of donors on relapse rates, patients with ALL, AML, and CML must be included in the data. The
main issue with the GVHD is that the donor cells think that the patient’s body is foreign and
proceed to attack it. This can cause various complications and may cause chronic forms of
GVHD. The HLA-A, HLA-B, and HLA-C matching donor types are affiliated with a higher
survival rate than the HLA-DRB1, -DQB1, and -DPB1 matching donor types (less than 0.001 of
the population in the case study died with the A, B, and C alleles). According to the article, a
mismatching donor type is involved with a higher chance of mortality than a matching donor
type. Additionally, the HLA-C matching and -DPB1 matching donor types led to a lower risk of
leukemic relapse. When the patient has an HLA-C mismatching donor type, it may also reduce
relapse rate, but it significantly increases the rate of GVHD. Using more than 1 HLA
mismatching donor alleles still requires more research to weigh the consequences and effects on
other factors. The authors conclude that the effects of a mismatched donor on the patient depends
on the severity of the patient’s condition, and that an HLA-matched donor should be used if the
patient is in critical care. Overall, the results of the rate of relapse may vary based on the type of
transplant performed and the availability of a donor.
The main author that wrote this article is Dr. Yasuo Morishima. Along with the multiple
authors he has written, he works with his colleagues at the Aichi Cancer center in the
Department of Hematology and Cell Therapy in Japan. He has written and contributed to articles
on different transplantation methods, graft versus host disease, and the treatment of patients with
Leukemia using conditioning. The authors specifically describe the benefits of each donor option
and how an HLA-matched donor is a better option than a mismatched donor. They list six
different matching/mismatching donor alleles and discuss whether each will lead to a higher
survival rate or a lower relapse rate. The authors then make comparisons between each of these
donor types depending its effect on GVHD, leukemia relapse, survival rate, mortality rate, and
neutrophil engraftment. The authors first explain in the first few pages of the article that there are
multiple factors affecting the rate of relapse and survival and discusses the main one-the donor
type. The first sentence of the article states, “​We hypothesized that the compatibility of each
HLA loci between donor and patient induced divergent transplant-related immunologic
responses, which attributed to the individualized manifestation of clinical outcomes”
(Morishima). The article then mentions each donor type and its impact on the factors listed
above. The author also adds in later paragraphs that the donor type is not the only factor that has
an effect on the patient. He includes that, “Patient age affected acute GVHD, chronic GVHD and
mortality, and donor age affected chronic GVHD and mortality” (Morishima). Along with the
evidence that the donor types can affect GVHD and mortality, the authors also provide an
explanation for the fact that other factors can affect GVHD and mortality, and that its not only
one factor.
Written in 2015, this science-related source is current. This article is mainly for doctors
working on finding the best available donor for their patient that will lead to a higher survival
rate, but not an increase in relapse or GVHD. It also helps scientists decide the characteristics of
a donor and which one should be used depending on the patient's condition. This article can be
corroborated by “The effect of donor characteristics on survival after unrelated donor
transplantation for hematologic malignancy,” written by Craig Kollman. The article emphasizes
in the discussion portion of their article that, “​The importance of HLA matching is well known,
and priority is given to identifying the best available HLA-matched donor” (Kollman). Both
articles support the idea that an HLA-matching donor is subsequently better for the patient. It
also mentions that the donor age can determine the success of a patient’s transplant, and that its
not only the HLA-matching cells. Both articles contain data charts based on the characteristics of
the donors in their case study, and provide evidence for the change in mortality and GVHD rate.
Overall, Dr. Morishima article is highly detailed and specific by explaining each factor in
determining a patient’s survival. It first describes the main factors that affect a patient’s outcome,
and then provides evidence and reasoning for each of those claims. This is also a long, in-depth
article that discusses each HLA-matching/mismatching donor type that would help a patient
based on their condition, age, characteristics, etc.