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1.
目的 探讨单倍型异基因造血干细胞移植后发生巨细胞病毒(CMV)感染的临床特点及治疗.方法 对北京军区总医院血液科2011年1月-2013年1月采用单倍型异基因造血干细胞移植治疗的50例患者的临床资料进行回顾性研究,供者接受粒细胞集落刺激因子动员,采用骨髓加外周血干细胞联合移植,预处理方案以改良BUCY方案为主,移植后监测CMV-DNA,分析CMV感染的特点并探讨其治疗方法.结果 全部患者中男32例,女18例,年龄5-45岁,平均年龄23.8岁,其中共12例发生CMV血症,发生率为24%,首次检出CMV-DNA中位时间是移植后50天(36-72),CMV定量范围为2.4×103-6.2×106拷贝/mL,其中6例为CMV相关性出血性膀胱炎,2例为CMV相关性间质性肺炎,抗CMV治疗后全部患者CMV-DNA转阴.结论 单倍型异基因造血干细胞移植后巨细胞病毒感染发生率高,更昔洛韦、膦甲酸钠抗病毒治疗疗效可靠、不良反应少.  相似文献   

2.
BACKGROUND: As the sequencing technology has been widely used and high-resolution confirmation of organ transplant matching has been gradually developed, new human leukocyte antigen (HLA) alleles are emerging. However, the gene frequency of some genes cannot be calculated accurately, and there are rare reports. These genes are often ignored, and it is easy to misjudge their genotypes only according to gene frequency. OBJECTIVE: To test and analyze a rare allele, HLA-C*08:99, from a volunteer donor of hematopoietic stem cell transplantation.METHODS:Genomic DNA was extracted automatically from the blood sample by using quick DNA purified kit and amplified by HLA-C locus commercial sequence-based typing kit. The purified PCR product was utilized as the DNA template in the sequencing reaction, and six direct sequencing reactions of PCR product covering exons 2, 3 and 4 in both directions were performed using commercial kit. Four direct sequencing reactions of PCR product covering exon 5 in both directions, exon 6 in forward direction and exon 7 in reverse direction were performed using in-house BigDye terminator cycle sequencing reaction kit. Sequencing reaction products purified by ethanol/sodium acetate/ ethylenediaminetetraacetic acid method were sequenced by ABI PrismTM3730 DNA Sequencer.RESULTS AND CONCLUSION: The allele assignment was analyzed with Assign-SBT 3.6+ software, and the sample HLA-C typing result was C*07:04, 08:99. Increasing the sequencing analysis at exons 5, 6 and 7 of HLA-C locus will help to make clear the ambiguous SBT result and improve the accuracy of HLA-C typing when it is necessary, which shows important significance in clinical tissue matching.  中国组织工程研究杂志出版内容重点:干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程  相似文献   

3.
人类白细胞抗原(human leukocyte antigen,HLA)系统是人类最复杂的遗传多态性系统。HLA群体遗传学的研究,一方面可揭示不同地区、不同民族的人群HLA分布情况,进行人群遗传学分析;另一方面有助于HLA与疾病相关性的研究以及为寻找HLA相合造血干细胞供者提供基础性资料。本文就HLA分子遗传基础、HLA群体遗传的内容及研究方法进展作一综述。  相似文献   

4.
目的 研究中国西南地区基诺族、佤族和毛南族中人类白细胞抗原(human leukocyte antigen,HLA)C等位基因及HLAⅠ类区域内C-B和A-C-B单倍型分布特点.方法 采用聚合酶链反应-序列特异性寡核苷酸分型技术(polymerase chain reaction- sequence specific oligonucleotide,PCR-SSO)对中国西南地区基诺族99名、佤族115名和毛南族85名进行HLA-C高分辨率基因分型,结合前期发表的HLA-A、-B分型结果,构建HLAⅠ类区域内HLA-A,-B和-C位点的单倍型.结果 3个群体中共检出HLA-C等位基因18种,其中基诺族中17种、毛南族中13种和佤族中15种.基因频率>10%的等位基因在这3个群体中的分布为:基诺族中从高到低依次为C*08:01、C*01:02、C*03:04和C*07:02;毛南族中依次为C*03:04、C*01:02、C*07:02和C*08:01;佤族依次为 C*12:03、C*08:01、C*07:02和C*04:01.基诺族中优势A-C-B单倍型包括A*02:07-C*01:02-B*46:01、A*11:01-C*08:01-B*15:02和A*11:01-C*03:04-B*13:01;毛南族中包括A*11:01-C*03:04-B*13:01、A*02:07-C*01:02-B*46:01、A*11:01-C*08:01-B*15:02和A*02:03-C*07:02-B*38:02;佤族中包括A*11:01-C*08:01-B*15:02、A*11:01-C*12:03-B*15:32和A*11:01-C*04:01-B*35:01.结论 基诺族、佤族、毛南族中HLA-C等位基因与HLA-A、-B位点构建的单倍型具有各自的分布特点,但单倍型C*08:01-B*15:02和A*11:01-C*08:01-B*15:02在3个群体中共有并呈高频分布,推测这两种单倍型可能是中国南方群体的祖先单倍型.另外,在基诺族、佤族和毛南族中各自具有其独特的优势单倍型.因此,HLA基因型和单倍型分布特点对这些群体的起源、迁徙、进化和疾病关联研究具有参考价值.
Abstract:
Objective To investigate the distribution of human leukocyte antigen(HLA) classⅠgenes and haplotypes in Jinuo, Maonan and Wa ethnic populations in southwest China.Methods Polymerase chain reaction-sequence specific oligonucleotide (PCR-SSO) typing by Luminex was performed to genotype the HLA-C alleles in unrelated healthy individuals in the three populations. HLA C-B, A-C-B haplotypes were computed by combining the previous HLA-A and -B genotyping data using Pypop7.0 software.Results Eighteen HLA-C genes were identified in the three populations, with 17, 13 and 15 HLA-C genes in Jinuo, Maonan and Wa populations respectively. The alleles with frequency of more than 10% from high to low were C*08:01,C*01:02,C*03:04 and C*07:02 in the Jinuo, C*03:04,C*01:02,C*07:02 and C*08:01 in the Maonan, and C*12:03,C*08:01, C*07:02 and C*04:01 in the Wa. The predominant HLA A-C-B haplotypes were A*02:07-C*01:02-B*46:01, A*11:01-C*08:01-B*15:02 and A*11:01-C*03:04-B*13:01 in the Jinuo, A*11:01-C*03:04-B*13:01, A*02:07-C*01:02-B*46:01, A* 11:01-C*08:01-B*15:02 and A*02:03-C*07:02-B*38:02 in the Maonan, and A*11:01-C*08:01-B*15:02,A*11:01-C*12:03-B*15:32 and A*11:01-C*04:01-B*35:01 in the Wa, respectively.Conclusion There were different characteristics in the distributions of HLA-C genes and HLA C-B, A-C-B haplotypes in the Jinuo, Maonan and Wa populations. However, haplotypes C*08:01-B*15:02 and A*11:01-C*08:01-B*15:02 with high frequencies were common in the three populations, which might be the common ancient haplotypes of southern Chinese population. The study of HLA genes and haplotypes in these populations may be of significance in the study of population genetics, transplantation and disease association.  相似文献   

5.
BACKGROUND:High-dose cyclophosphamide (CTX)-induced immunogenic tolerance following haploidentical allogeneic hematopoietic stem cell transplantation (allo-HSCT) is developed to optimize the treatment of childhood severe aplastic anemia (SAA) using haplotype allo-HSCT, providing a theoretical basis for the clinical application. OBJECTIVE:To investigate the clinical efficacy and safety of the use of high-dose CTX following haploidentical allo-HSCT in SAA children. METHODS:Clinical data from 10 children with SAA undergoing haploidentical allo-HSCT at the Department of Hematology, General Hospital of Beijing Military Area from January 2013 to January 2015 were retrospectively analyzed. Pretreatment was CTX, fludarabine, Busulfex combined with anti-human lymphocyte immune globulin used for 2 consecutive days, and then 3 days after transplantation, CTX (50 mg/kg per day) was used to induce immunogenic tolerance. Combined use of cyclosporin A, methotrexate and tacrolimus functioned as a prophylaxis for graft-versus-host disease. Another 10 SAA children who underwent synchronous HLA-identical sibling HSCT served as controls. Complications and survival in children were statistically analyzed in the two groups. RESULTS AND CONCLUSION:In the treatment group, children were followed up until May 2015, and the median follow-up period was 18.1 months (5-28 months). Hematopoietic reconstruction was successful in all cases, and there were three cases of graft-versus-host disease, three cases of pulmonary infection and two cases dying of pulmonary infection. In the control group, the median follow-up period was 20.7 months (6-27 months), and all the children received hematopoietic reconstruction. Additionally, there were two cases of graft-versus-host disease, four cases of pulmonary infection, one case dying of graft-versus-host disease and one case dying of pulmonary infection in the control group. The total survival rate in each group was 80%. In summary, high-dose CTX-induced immunogenic tolerance is safe and effective for SAA children undergoing haploidentical allo-HSCT, which makes the clinical efficacy of haploidentical allo-HSCT identical to that of matched HSCT.  相似文献   

6.
背景:单倍型造血干细胞移植是治疗恶性血液病的一种有效方法,合适的供者及快速查找到合适的供者有助于提高移植的成功率。 目的:比较父母供子女单倍型造血干细胞移植治疗恶性血液病的临床疗效。 方法:对郑州大学第一附属医院92例恶性血液病患者行父母为供者的单倍型造血干细胞移植治疗,分为父供子移植、父供女移植、母供子移植、母供女移植4组,对比4组患者移植物抗宿主病的发生率、复发率、2年无病生存率及总生存率等。 结果与结论:92例患者均完全植入并获得造血重建,4组急性移植物抗宿主病发生率、慢性移植物抗宿主病发生率和复发率差异无显著性意义(P > 0.05)。但4组Ⅲ、Ⅳ度急性移植物抗宿主病发生率、2年无病生存率、2年总生存率差异有显著性意义(P < 0.05)。其中父供子移植组、母供女移植组的Ⅲ、Ⅳ度急性移植物抗宿主病发生率低于父供女移植组和母供子移植组;同时父供子移植组和母供女移植组的2年无病生存率、2年总生存率高于父供女移植组和母供子移植组。可见父母供子女单倍型造血干细胞移植是安全可行的,供受者性别相同比供受者性别不同的疗效好。  相似文献   

7.
人类白细胞抗原-A基因芯片分型研究   总被引:1,自引:0,他引:1  
目的 探索人类白细胞抗原-A(HLA-A)基因芯片分型,为器官移植临床配型服务。方法 根据中国汉族南方人常见的HLA-A位点基因及其多态性的独特序列,设计并合成48条特异性的寡核苷酸分型探针,将其点在玻片上,制成芯片。基因组DNA通过组间特异性引物扩增,并用荧光素Cy5标记。标记后的产物与结合在芯片上的探针进行杂交,通过荧光扫描仪获得杂交产生的荧光信号值,再经过计算机软件自动分析,确定样品的HLA-A基因亚型。用该方法对120份样本进行HLA-A基因分型。结果 120份待检样本,其中6份因PER无产物,不能分型。1份信号杂乱,不能分型。其余113份样本分型成功。实际检出A抗原特异性结果为A2(含A203):56;A11(含A1101):52;A24:33;Al:8;A30(含A3001):7;A33:21;A26:1;A29:2;A31:3;A68:2;A3:9;A32:1。未检出A*3002基因型。整个检测耗时约4.5h。芯片检测的重复率为100%。结论 HLA-A基因芯片是一种理想的分型方法,具有特异性高、重复性好、操作简便、所需样本量少、结果判读容易、一次可作多份样本的优点,适合临床器官移植配型应用。  相似文献   

8.
标准的清髓性异基因造血干细胞移植(allo-HSCT)对于需代替治疗的造血与免疫系统的非恶性疾病,应当是合理或足够的;然而,对于恶性血液病患者,清除患者骨髓造血组织,成功重建异体正常造血与免疫系统,并不一定能完全治愈恶性血液病,因为白血病(干)细胞并非只限骨髓中存在,它可浸润骨髓之外的其他任何组织。临床实践证实,allo-HSCT后仍然有30%左右的患者疾病复发,特别是具有高危因素或难治复发患者复发率可高达40%~70%以上。这些复发的白血病细胞几乎全系源自患者移植前本身的白血病细胞,其中半数患者以髓外部位复发开始,有证据提示,清髓性移植并没有完全杀灭患者体内的白血病细胞,特别是那些对化放疗不敏感或栖居在髓外"庇护所"中的白血病干细胞,最终导致疾病复发。因此笔者提出并建立了一个清肿瘤性异体造血干细胞移植(TAHSCT)的概念,在临床上对其进行了初步的探讨。其内容贯穿于移植技术全过程的各个环节,但主要为应用个体化清肿瘤性预处理方案和加强移植后免疫治疗。  相似文献   

9.
人类白细胞抗原分子遗传中的基因重组   总被引:7,自引:0,他引:7  
深入研究人类白细胞抗原(human leucocyte antigen,HLA)基因重组的分子生物学特性,对于揭示其等位基因多样性形成的演化机理以及人体所具有的抵抗多样致病微生物的防御能力具有重要意义。国外学者通过家系调查研究、统计学分析等方法估算了HLA的重组频率,证实了一些重组发生的热点,并且对重组的单倍型特异性、序列基序特异性、性别特异性等进行了深入研究。本文就HLA重组的交换频率、重组热点以及其它特性的研究现状作一综述。  相似文献   

10.
目的 研究中国人群等待造血干细胞移植受-供者人类白细胞抗原(human leukocyte antigens,HLA)-A、-B、-Cw、-DRBl、-DQB1 5个位点的等位基因及核苷酸匹配情况,从单核苷酸水平探讨最佳供选择方案.方法 采用聚合酶链反应测序分型法(polymerase chain reaction-sequence-based typing,PCR-SBT),对537对中国人群等待造血干细胞移植受-供者HLA-A、-B、-Cw、-DRB1、-DQB1位点的等位基因进行序列分型,应用BLAST工具分析受-供者HLA核苷酸差异.结果 37对受-供者中HLA-A、-B、-Cw、-DRB1、-DQB1五位点核苷酸完全匹配占16.20%,单个等位基因错配的受-供者对分别占8.38%,0.74%,12.29%,2.42%和2.79%,两个或两个以上等位基因错配比率占42.65%.检出A*02:01-A*02:06,A*02:06-A*02:07,Cw*03:04-Cw*15:02,Cw*03:03-Cw*04:01,Cw*03:04-Cw*14:02,Cw *03:03-Cw*08:01,DRB1*04:03:01-DRB1*04:05不容许错配等位基因对.两对受-供者B*07:05:01-B*07:06,Cw*07:01:01-Cw*07:06抗原识别区外核苷酸错配.结论 在造血干细胞移植选择HLA错配的无关供者时注意受-供核苷酸匹配差异,对HLA抗原识别区内的核苷酸匹配差异和抗原识别区外的核苷酸匹配差异应当加以区别.本研究结果为优化供者选择顺序提供科学参考数据.  相似文献   

11.
We present high-resolution allele and haplotype frequency (HF) estimations of the Polish population based on more than 20,000 registered stem cell donors. Sequencing-based donor human leukocyte antigen (HLA) typing led to unambiguous typing results in most cases (between 94.3% for HLA-DRB1 and 96.9% for HLA-B). HF estimations were carried out with a new, validated implementation of the expectation-maximization algorithm that allowed processing of data with ambiguities. Our results confirm several earlier results, for example, the relative commonness of the haplotype A*25:01 g, B*18:01 g, C*12:03, DRB1*04:01 in the Polish population. Because of the large sample size, we were able to obtain results of unprecedented accuracy. The estimated population-specific HFs were then used to analyze questions of strategic donor registry planning. Simulated matching probabilities by donor file size suggest that there is a need for intense donor recruitment efforts in Poland despite the large German donor registry and the genetic relatedness of both populations. Based on the current German registry size of approximately 4 million donors, the recruitment of 100,000 Polish donors would produce a stronger increase in matching probabilities for Polish patients than the recruitment of 3.3 million additional German donors.  相似文献   

12.
The polymorphism of the HLA class II genes DRB1, DQA1, and DQB1 was investigated in 100 unrelated Iranian individuals from Fars province in Southern Iran, using the restriction fragment length polymorphism (RFLP) method. Subtyping of DRB1*04, *15, and *16 alleles was performed using PCR amplification with sequence specific primes (PCR-SSP). The allele and the haplotype frequencies were calculated. The most common DRB1 alleles were DRB1*11, DRB1*15, and DRB1*04 with a frequency of 25.0%, 14.5%, and 10.5%, respectively. In contrast, the allelic frequency of DRB1*12 and DRB1*08 was very low (1.5% for each). In the DR15 group DRB1*1501 was the most prevalent variant (6.0%). Concerning DR4, the most common alleles were DRB1*0405 and DRB1*0402 (3.5% for each). Interestingly, DRB1*0402 was associated with DQB1*0302 and DRB1*0405 was associated with DQB1*0302 and DQB1*02, the latter being a rare DRB1/DQB1 haplotype in Caucasian individuals. The most frequent DQB1 alleles were DQB1*0301 (31.0%), and DQB1*05 (22.0%). The most frequent DQA1 variants were DQA1*0501 (39.0%) and DQA1*0102 (14.5%). The most common haplotype was DRB1*11-DQB1*0301-DQA1*0501 (25.0%) followed by DRB1*0301-DQB1*02-DQA1*0501 (10%) and DRB1*0701- DQB1*02-DQA1*0201 (6.5%). Data presented in this study suggest that the Iranian population shares some HLA components with populations resident in eastern and southern European countries.  相似文献   

13.
Human leukocyte antigen (HLA) DR15 is associated with autoimmune cytopenia in patients with aplastic anemia, myelodysplastic syndrome, and paroxysmal nocturnal hemoglobinuria. Presence of this antigen also predicts response to immunosuppressive treatment. If DR15 expression on hematopoietic cells also favors induction of immune responses in an allogeneic setting, a lower relapse rate after hematopoietic stem cell transplantation (HSCT) might result through an enhanced graft-versus-leukemia effect. We retrospectively analyzed outcome of HLA-identical sibling HSCT in 192 consecutive patients with acute or chronic leukemia or non-Hodgkin lymphoma. Patients carrying the DR15 antigen had a higher estimated 5-year overall survival (76%) than did DR15-negative patients (55%; P = .04). Improved survival for DR15 patients was due to a significant decrease in death from relapse (5% for DR15(+) versus 24% for DR15(-); P = .02), whereas no difference was seen for rates of transplant-related mortality (19% and 21%, respectively; P = .76). Findings were confirmed by multivariate analyses. Our results show an association of DR15 with a decreased risk of disease relapse and improved survival after HSCT for leukemia or non-Hodgkin lymphoma. This adds to the growing list of links between DR15 and immune reactions in hematopoiesis.  相似文献   

14.
背景:ABO血型不合供受者之间进行外周血造血干细胞移植,面临受者血型的转变、移植后输血的选择等问题。 目的:观察ABO血型不合外周血造血干细胞移植治疗血液病的临床疗效和近远期并发症。 方法:回顾性分析了2005/2008武警总医院收治的10例ABO血型不合异基因外周血同胞供者造血干细胞移植患者的资料。总结植入效果,血型转变,移植物抗宿主病以及不良反应。 结果与结论:9例患者恢复造血功能,血型转变为完全供者型,1例患者白细胞血小板恢复,但红细胞植入延迟。所有患者在输注移植物时未出现短暂的血红蛋白尿,无严重急性溶血和迟发型溶血的发生,1例出现严重的移植物抗宿主病。可见ABO血型不合外周血造血干细胞移植对移植疗效无明显影响,红细胞植入延迟的预防和处理十分重要。  相似文献   

15.
BACKGROUND:Allogeneic hematopoietic stem cell transplantation (HSCT) is one of the effective methods in the treatment of leukemia. The haploidentical HSCT is an option for the patients who need a HSCT without a human leukocyte antigen (HLA)-matched donor. OBJECTIVE:To study the clinical efficacy of HLA-haploidentical HSCT on leukemia and its complications. METHODS:A total of 23 patients (4 cases of acute lymphoblastic leukemia, 12 of acute myelogenous leukemia, and 7 of chronic granulocytic leukemia) who had been treated with HLA-haploidentical HSCT from November 2007 to March 2015 were enrolled. Conditioning regimen I was set as cyclohexyl nitrosourea+cytarabine+busulfan+cyclophosphamide; regimen II as cyclophosphamide+total body irradiation; regimen III as fludarabine+cytarabine+busulfan+cyclophosphamide; and regimen IV as busulfan+cyclophosphamide. Cyclosporin A, mycophenlate mofetil, antithymocyte globulin and methotrexate were used to prevent graft-versus-host disease (GVHD). Hematopoietic remodeling, complications and prognosis were observed in all patients undergoing HLA-haploidentical HSCT. RESULTS AND CONCLUSION:Of the 23 patients, 22 achieved reconstitution of the granulocyte series, and 19 achieved reconstruction of the megakaryocyte series. Additionally, there were 7 cases of acute GVHD and 4 of chronic GVHD. Transplant-related mortality was 22% (5/23) within 100 days post transplantation including graft failure, acute GVHD, intracranial hemorrhage and disseminated infections. There were 14 cases of disease-free survival from 100 days to 24 months post transplantation, 2 cases of death due to GVHD and fungal infection, or recurrence and chronic GVHD, and 2 cases of recurrence under treatment. These findings indicate that HLA-haploidentical HSCT is an effective approach for the treatment of patients with leukemia, which is worth further investigation in clinical practice.  相似文献   

16.
17.
Immunogenomics of hematopoietic stem cell transplantation   总被引:2,自引:0,他引:2  
Recipients of allogeneic hematopoietic stem cell transplantation (HSCT) incur the risk of graft-versus-host disease even when the donor is a sibling who shares the Major Histocompatibility Antigens. Therefore, even the perfect HLA match does not represent the optimal genetic match between donors and recipients in HSCT. In addition to the HLA complex other genetic systems operate and affect the outcome of HSCT. These include minor histocompatibility systems (Martin P. Applicability of matching for minor histocompatibility antigens in human bone marrow transplantation. In: Roopenian DC, Simpson E, editors. Minor histocompatibility antigens: From the laboratory to the clinic. Georgetown: Landis Bioscience; 2000. p. 97-103) (inducing bona fide allogeneic responses) as well as a series of functional polymorphisms in cytokines and chemokines and receptors genes (Transplantation 1997;64:553). Among the items affecting the outcome of HSCT the incidence and severity of infections have an important impact. Polymorphisms of genes controlling both arms of the immune responses to pathogens (innate versus cognate) are strong candidates for susceptibility factors to infection in allogeneic transplantation. These include the MHC alleles (HLA class I, class II, MIC) CD1, Toll and TLR genes MBP, MPO genes, ...). In addition to the NK alloreactivity induced by HLA class I epitopes mismatching (a common situation in HSCT) variations in the genotype of the KIR genes (Tissue Antigens 2001;57:358) may also be encountered between the donor and the recipient leading to potentially harmful or beneficial combinations. An integrated knowledge of the role and hierarchy of the most important genetic factors (MHC and non-MHC) will provide the rationale for a comprehensive matching in HSCT (Curr Opin Hematol 3 (1996) 416). This short review provides a panorama of this strategic issue for further development of HSCT.  相似文献   

18.
In 2013, ~1,329,300 individuals made up the South African Indian population, which constituted ~2.5% of the total population of ~53 million. Historically, from 1860 to 1911, indentured labourers were imported from India, to work in the sugar-cane plantations in the KwaZulu-Natal Province. The local Indian community was further augmented by “passenger” immigrants who paid for passage to South Africa. Extensive HLA allelic variability exists in mainland Indian populations. We investigated HLA-A, -B and -C allele and haplotype diversity in 50 healthy, unrelated individuals recruited from the South African Indian population for comparison to data from mainland India.  相似文献   

19.
Human leukocyte antigen (HLA)-E is an inhibitory ligand of natural killer cells and γ/δ T-cells. Differential expression of HLA-E alleles on the cell surface has been reported to influence outcome of hematopoietic stem cell transplantation (HSCT). We performed HLA-E genotyping in 116 HSCT patients and their HLA-matched unrelated donors. The impact of HLA-E genotypes on patient's overall survival (OS), disease free survival (DFS), cumulative incidences for relapse, transplant-related mortality (TRM) and acute graft vs host disease (aGvHD) was assessed. Neither univariate nor multivariate analysis showed any influence of HLA-E polymorphisms on the investigated endpoints of HSCT in our cohort. We could not confirm any of the previous observations in our cohort and consider it unlikely that HLA-E polymorphisms affect outcome of HSCT.  相似文献   

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