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The benefits of HLA matchmaker and PIRCHE score algorithms in haploidentical hematopoietic stem cell transplantations

In an effort to avoid alloreactive responses afterhaploidentical hematopoietic stem cell transplantation(haplo-HSCT) it is important to identify and minimizethe number of HLA-mismatches between donor andrecipient. One of the possibilities is to apply algorithmsthat quantifies the structural and functional differencesbetween a recipient's and donor's HLA antigens. We ana-lyzed a cohort of 64 adult patients with hematologicmalignancies who received a transplant from a relatedhaploidentical donor at the Clinical Hospital CenterZagreb. HLA eplet- mismatches (EM) calculated by theHLAMatchmaker algorithm as well as PIRCHE score(PS) data among patients and their haplo-identicaldonors were analyzed in both directions, graft versus host(GvH) and host versus graft (HvG). The effect on graftversus host disease (GvHD) and relapse incidence wereestimated. The median of total HLA class I and class IIEM was 38 (range: 11–60), with the mismatches predomi-nately found in the HvG direction (median 23, range: 5–52) as compared to the GvH direction (median 15, range:0–25). The median HLA class I PS in the GvH directionwas 16 (range: 1–48), and the median HLA class I PS inthe HvG direction was 16 (range: 0–59). Patients withHLA class I+II EM <15 (73.7%) in comparison topatients with HLA class I+II EM >15 (26.3%) demon-strated significantly higher incidence of relapse(P=0.0243 ; RR=2.80 ; 95% CI [1.14– 6.86]). The patientswith HLA class I PS >20 in the GvH direction had a sig-nificantly higher (P=0.0081) incidence of GvHD whichwas also confirmed in a multivariate analysis (P=0.0420 ; OR=4.09 ; 95% CI [1.05–15.89]). The resultsof this study confirm the HLAMatchmaker and PIRCHEscoring algorithms as a useful tool in prediction of per-missible HLA mismatches and improve the selection of abest haplo-donor.

HLA matchmaker, PIRCHE, HSCT

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