Introduction

Transplantation of allogeneic hematopoietic stem cells is a potentially curative treatment for a number of hematologic malignancies and other diseases.1 The best success of this therapy is achieved using HLA-identical sibling donors, but only 30-35% of patients have such donors. Alternate donors that have been used include partially HLA-matched related donors and unrelated donors. The use of alternate donors is generally associated with increased rates of severe complications and mortality. Efforts to reduce complications associated with alternate-donor transplantation include HLA matching and protocols designed to improve engraft-ment and reduce graft-versus-host disease (GVHD).

The HLA complex is intimately involved in human allogeneic stem cell transplantation, being critically involved in GVHD, graft failure, and graft-versus-leukemia (GVL) effects. Each of these is a reflection of the normal function of HLA molecules in immune responses to pathogenic agents. The principle functions of HLA molecules are to bind peptides and to serve as recognition elements for T lymphocyte and natural killer (NK) cell receptors.23

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