Searches For Hlamismatched Unrelated Donors

For a significant fraction of patients a fully matched donor may not be obtained. Tiercy and colleagues138 indicated that their patients for whom full HLA-matched donors were not found fell into four categories (1) a rare allele in the patient, (2) an unusual B-DR or DR-DQ haplotype in the patient, (3) an antigen that is split into more than two alleles with greater than 10% frequency (e.g., DRB1*04), (4) a B antigen that has multiple Cw associations (e.g., B*51). Since some patients can do well with mismatched donors, the issue may become finding prospective donors that represent minimal mismatches to the patient, as discussed previously. Given the high level of linkage disequilibrium, especially between HLA-B and -Cw and between DR and DQ, mismatches at B or DR are very often also found to be mismatched at Cw or DQ, respectively. This may affect the choice of prospective donors on whom to perform additional testing to avoid multilocus mismatches.

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