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Complete donor chimerism following 0/10 HLA-mismatched unrelated donor allogeneic hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 53, pages 1578–1582 (2018)Cite this article

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Several factors are considered in the selection of a compatible donor for an allogeneic HSCT (allo-HSCT), the HLA matching being the most important. An HLA-matched sibling remains the preferred donor for allo-HSCT, but only 30% of patients have this type of donor available [1, 2]. As an alternative, a matched unrelated donor (MUD) matching at  ≥8 of 10 HLA alleles can be used. This level of HLA compatibility is sought in order to reduce the risk of GvHD—a major clinical complication of transplantation—as well as graft failure [3]. Another strategy expanding the number of available stem cell donors is the application of haploidentical transplants. But this source of donors has  the disadvantage of an increased risk of serious GvH reactions, delayed immune reconstitution, and graft failure [4]. As exemplified by the concept of non-myeloablative transplantation, a balance between modern immunosuppression and graft disparity can be highly beneficial to patients with hematological malignancies as graft-versus-tumor effects are empowered while GvHD is reduced [5].

We have previously reported on a catastrophic inadvertent event, where a patient with refractory T-cell lymphoma was infused with stem cells from an incorrect donor matched at 0/10 typed HLA loci [6]. We have strived to learn from this tragic incident and now report on the immunological and molecular studies performed to elucidate the immune reconstitution and its implications for future transplantations.

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Acknowledgements

We thank Betina Sørensen and Anni Aggerholm for details on HLA type and chimerism measurements. We acknowledge the contribution of Line Nederby in the collection of patient material. Technical expertise from Anni Skovbo was highly appreciated. Flow cytometry was performed at the FACS Core Facility, Aarhus University, Denmark.

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Authors and Affiliations

  1. Department of Biomedicine, Aarhus University, Aarhus, Denmark

    Camilla Darum Sørensen & Marianne Hokland

  2. Department of Clinical Immunology, Aarhus University Hospital, Skejby, Aarhus, Denmark

    Bjarne Kuno Møller

  3. Department of Hematology, Aarhus University Hospital, Aarhus, Denmark

    Gitte Olesen & Peter Hokland

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  1. Camilla Darum Sørensen
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  2. Bjarne Kuno Møller
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Correspondence to Marianne Hokland.

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Sørensen, C.D., Møller, B.K., Olesen, G. et al. Complete donor chimerism following 0/10 HLA-mismatched unrelated donor allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 53, 1578–1582 (2018). https://doi.org/10.1038/s41409-018-0229-y

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