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Current donor selection in allogeneic bone marrow transplantation relies on serological HLA identity and negative mixed lymphocyte reaction (MLR) between donor/patient pairs. However, serological HLA typing and MLR are not always attainable because the constitution of peripheral blood in some patients particularly with hematopoietic disorder is quite different from that in normal healthy individuals. We analysed these cases that the histocompatibility between donor/patient pairs could not be determined by serological typing or MLR, and characterized the composition and proliferative response of peripheral blood mononuclear cells (PBMC) and performed HLA class II-DNA typing in order to determine the histocompatibility between them.In unattainable cases for serological HLA typing, CD 19-positive B cells were undetectable by flowcytometric analysis. In unattainable cases for MLR, the decrease of HLA-DR-positive cells was observed by flowcytometric analysis and proliferative response to PHA and ConA were lower than that in normal PBMC. These results indicate that the infeasibility of serological HLA typing and MLR are due to the quantitative and/or qualitative abnormalities in the constitution of patient's PBMC.Finally, HLA-DNA typing could determine the genotypes of HLA class II region in these cases. Thus, HLA-DNA typing is very useful for donor selection and may be adopted for histocompatibility testing in the future.

Usefulness of HLA DNA typing in unattainable cases for histocompatibility testing in allogeneic bone marrow transplantation.