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HLA IDENTICAL COUSIN IDENTIFIED AS STEM CELL DONOR.
Linda S. Buckert, BS , Jane N. Zappia, BS , Ronaldo Deang BS , Roberta Bamert BS and Yuichi Iwaki MD, PhD . Loma Linda CA, Loma Linda University Medical Center, 92354, HLA Laboratory .
A six-year-old with acute myeloid leukemia presented to our institution. Stem cell transplant was determined to be an option for treatment. A search was begun for finding a donor within her immediate family, but with the decreasing size of families today, the odds of finding an HLA identical sibling are often difficult. The average family size in our geographic area is 3.65 (US Census 2000).
The patient (a/c), father (a/b), mother (c/d), and two siblings were tested by SSP (Pel-Freez). The parents shared one HLA haplotype as expected. The brother (b/c) shared the maternal haplotype and the sister (b/d) did not share any haplotypes with their affected sister. Eager to find a donor, the patient’s physician also sent the paternal grandfather and aunts and uncles for HLA typing by serology. After analysis of the family tree, it was discovered that one of the maternal uncles (c/d) had married a paternal aunt (a/b). Further investigation revealed that this family had three offspring. These three cousins were tested and one of them was found to be HLA identical with the patient. Molecular typing was done to confirm the HLA match.
HLA typing, persistence, and a thorough family interview provided the path for finding an HLA identical donor for our patient. The patient was successfully transplanted with peripheral stem cells harvested from the HLA identical cousin.
HLA Haplotype Chart Patient a A*25,B*1509,Cw*07,DRB1*04, DQB1*03 c A*24,B*39,Cw*07,DRB1*08,DQB1*04 Father a A*25,B*1509,Cw*07,DRB1*04, DQB1*03 b A*30,B*13,Cw*06,DRB1*07,DQB1*02 Mother c A*24,B*39,Cw*07,DRB1*08,DQB1*04 d A*02,B*44,Cw*16,DRB1*07,DQB1*02 Cousin a A*25,B*1509,Cw*07,DRB1*04, DQB1*03 c A*24,B*39,Cw*07,DRB1*08,DQB1*04