Major Histocompatibility Complex 2018; 25 (: 128 138 抄録集 2018 4 14 A 3 128
MHC 2018; 25 ( HLA 2013 10.5 10 8 12 10 8 2016 CD34 + HLA NC 10 8 CD34 + CD34 + 10 6 NC10.5 2013.Apr 2014.Mar NC11 2014.Apr 2016.Jun NC12 2016.Jul 2016. Sep NC12 CD34 + 2 2016.Oct 2017.Jul 1 NC 10 CD34 + 2.5 2 3 HLA 1 50 kg NC 10 CD34 + 2.5 37.1% 45.9% 64.5% 77.0% 2 80 62 58 260 192 189 3 HLA 12% 6/6 3% 2 60% 76% HLA HLA 3) 3) 3) 3) 3) 3) 3) HLA-A, -B, -DRB1 3 2 HLA HLA HLA 6 1374 HLA HVG HLA 500/ l multivariable competing risk regression HLA-A, -B, -C HLA 129
MHC 2018; 25 ( Risk of neutrophil engraftment by the number of HLA locus mismatch in allele level. N Hazard Ratio HLA-A, B, C, DRB1 mismatch* 0 53 1.00 [95% C.I.] P>z 1 152 0.90 0.64 1.26 0.524 2 293 0.71 0.52 0.98 0.040 3 593 0.73 0.53 0.99 0.042 4 336 0.62 0.45 0.86 0.004 HLA-A, B, C mismatch* 0 123 1.00 1 253 0.76 0.61 0.96 0.020 2 571 0.76 0.62 0.94 0.011 3 480 0.65 0.52 0.81 0.000 HLA-A, B, C mismatch* 0 123 1.00 1 or 2 824 0.76 0.62 0.93 0.009 3 480 0.65 0.52 0.81 <0.001 * HVG direction HLA ATG HLA ATG 2009 8 2017 6 GVH 33 ATG 18 15 ATG UR-BM 13 UR-PB 5 UR-BM 15 ATG 16% 20% ATG CMV 20% 22% 1 OS PFS 63% vs 31% P=0.151 48% vs 31% P=0.197 ATG 1 35% vs 21% P=0.57 ATG Day100 Grade II agvhd 29% vs 30% P=0.861 cgvhd 1 33% vs 74% P=0.04 cgvhd 0% vs 30% HLA ATG cgvhd ATG CMV 130
MHC 2018; 25 ( HLA-DPB1 3) 4) 3) 3) 4) JMDP UR-HSCT HLA- DPB1 GVHD HLA-DPB1 HLA-DPB1 T-cell epitope TCE functional distance FD dfd>2.665 dfd 2.665 Blood. 2016; 128: 120 UR-HSCT FD 1993 2010 JMDP UR-HSCT HLA-A, B, C, DRB1, DQB1 HLA-DPB1 1968 HLA-DPB1 dfd GVHD 1968 dfd 2.665 1569 dfd>2.665 399 GVHD 2 4 dfd>2.665 Hazard ratio HR 1.25, P=0.008 GVHD 3 4 HR 1.20, P=0.196 HR 0.81, P=0.095 HR 1.01, P=0.926 UR-HSCT dfd>2.665 non-permissive non-pm mismatch dfd GVHD 2 4 GVHD UR-HSCT dfd>2.665 non-pm HLA MSC T MSC HLA CD80 CD86 CD40 T T MSC HLA GVHD GVHD MSC 2 2016 2 MSC GVHD 10 4 6 MSC 131
MHC 2018; 25 ( MSC MSC GVHD 2 MSC MSC I HLA 3 EBV CTL EBV EBV- LPD CD20 LPD EBV- LPD T CTL I CTL CTL CTL off the shelf CTL HLA GVHD GVHD EBV-LPD CTL I 2 4 CTL 2 CTL EBVDNA 1 TLR4 +3725G>C toll-like receptor TLR family TLR HLA Uchino K. Oncotarget 2017; Uchino K. Transplant Immunol 2016 TLR4 rs11536889, 132
MHC 2018; 25 ( +3725G>C G/G TLR4 +3725G>C 21 TLR4 G C/G G/G G C/C TLR4 TLR4 +3725G>C TLR4 +3725G/G TLR4 TLR4 +3725G>C HLA class II 3) 3) 3) 3) HLA HLA Donor HLA Specific Antibody DSA de novo DSA HLA class II B HLA EA.hy926 HUVEC IFN 48 HLA-DR In cell analyzer mrna qrt-pcr EVR FLU PRD HLA-DR FLU HLA PRD CIITA EVR mrna HLA-DR EVR EVR FLU HLA CD63 CD82 DSA de novo DSA HLA-DR DSA HLA 133
MHC 2018; 25 ( HLA 1 HLA DSA AMR DSA AMR 37 DSA 9 RAI 6 14 RAI 5 9 21 C4d AMR 2 50 g/ 2 DSA Mean fluorescence intensity: MFI Class I 14500 AMR MFI:2000 DSA AMR Rituximab DSA DSA 2012 11 HLA 2014 10 DSA rituximab 500 mg/body FK506 MMF 3 10 12.5% DSA 9 rituximab 1 21 AMR DSA class- I DSA class-ii DSA Non-DSA DSA class-ii DSA 3 C4d DSA class-i MFI rituximab 1 DSA 134
MHC 2018; 25 ( Rituximab DSA 1 De novo DSA HLA 3) 3) HLA HLA class II HLA class II HLA HLA de novo DSA HLA 923 de novo DSA 147 776 DRB1 04:05, DRB1 09:01 HLA class II HLA p<0.05 in vitro DSA LABScreen Single Antigen Virtual crossmatch CDCXM T cell B cell FCXM T cell HLA high risk LAB- Screen Single Antigen SA SA virtual crossmatch VXM 59 15 SA B44 B45 B76 135
MHC 2018; 25 ( CDCXM FCXM VXM B76 HLA cross-reactive group CREG B76 MFI 1367 1 rituximab 200 mg 6 2 Cre 1.57 mg/dl protocol SA VXM HLA ABO-I HLA HLA-I ABO-I IVIG 1990 HLA-I IVIG 2008 HLA-I IVIG 4 FCXM LABScreen MFI 1 64 3 LCT FCXM T- cell(+) B-cell(-) LABScreen PRA class I 0% class II 3% class II LABScreen single beads class I class II DSA MFI 2254 FCXM T-cell(-) B-cell(+) LABScreen single beads class I DSA MFI 4221 non- DSA class I, class II 20 MFI 6512 1 TAC, MMF, PSL rituximab 3 9 DFPP 5 136
MHC 2018; 25 ( IVIG 5 100 g 3 IVIG Cr 0.8 mg/dl AMED 10 1 2 3 1 2 3 CQ Precision Medicine Precision Medicine NK IgG Fc RIII ADCC ADCC Fc RIIIa IgG3 158F-carrier 158V/V 137
MHC 2018; 25 ( NK Fc RIIIa 158F-carrier T FOXP3 Rs3761548 CC major allele FOXP3 minor allele A-carrier FOXP3 CC-homozygote A-carrier A-carrier CC-homozygote FOXP3 A-carrier 138