. "2" . . "unrelated; haematopoietic stem cells; transplantation; HLA"@en . . . "98290" . . "Praktick\u00FD pohled na v\u00FDznam HLA shody pro transplantaci krvetvorn\u00FDch bun\u011Bk od dosp\u011Bl\u00FDch nep\u0159\u00EDbuzn\u00FDch d\u00E1rc\u016F"@cs . . "Transfuze a hematologie dnes" . "RIV/00669806:_____/13:10138998" . "[171328B2BC12]" . "The therapeutic effect of unrelated donor stem cell transplantation (SCT) is predominantly determined by genetic nonidentity - HLA-mismatch - between recipient and donor. This facilitates both the desirable graft versus leukaemia (GVL) effect, which reduces the risk of relapse in malignancies as well as the graft-versus-host disease (GVHD), which increases mortality. This paper attempts to summarize the current view on the overall significance of HLA match and to interpret the qualitative and quantitative effect of mismatches in individual HLA genes on the outcome of SCT from an unrelated adult donor, particularly in malignant diseases. The current standard involves an effort to find an allele-level matched donor at least in HLA-A,-B,-C,-DRB1, because isolated mismatch in each of these genes increases mortality by approximately 10% and multiple mismatches actually have a negative synergistic effect. However, the consequences of incompatibility are significantly influenced by disease stage, as in high-risk patients these are much less significant or even negligible because of the accentuated GVL response. With the possible exception of the HLA-C locus, mismatches either on allelic or antigenic level seem to be comparably tolerated in peripheral blood stem cell transplantation. If it is necessary to accept a mismatched donor, then in the case of bone marrow it is best to avoid mismatches in HLA-A and DRB1, while in the case of peripheral blood stem cells the worst tolerated %22antigenic%22 mismatch involves HLA-C. Apart from HLA match, there are many factors on the donor side that affect SCT outcome. These especially include timely transplantation, as the speed of finding an unrelated donor and SCT within the shortest possible time are almost as important as the degree of HLA-compatibility."@en . "Praktick\u00FD pohled na v\u00FDznam HLA shody pro transplantaci krvetvorn\u00FDch bun\u011Bk od dosp\u011Bl\u00FDch nep\u0159\u00EDbuzn\u00FDch d\u00E1rc\u016F" . "1"^^ . "Praktick\u00FD pohled na v\u00FDznam HLA shody pro transplantaci krvetvorn\u00FDch bun\u011Bk od dosp\u011Bl\u00FDch nep\u0159\u00EDbuzn\u00FDch d\u00E1rc\u016F" . . . . "1213-5763" . "Terapeutick\u00FD efekt nep\u0159\u00EDbuzensk\u00E9 transplantace krvetvorn\u00FDch bun\u011Bk (TKB) je nejv\u00EDce ur\u010Dov\u00E1n genetickou - HLA - neshodou mezi p\u0159\u00EDjemcem a d\u00E1rcem. Ta umo\u017E\u0148uje jak u malignit \u017E\u00E1douc\u00ED reakci \u0161t\u011Bpu proti leukemii (GVL - graft versus leukemia effect) sni\u017Euj\u00EDc\u00ED riziko relapsu, tak reakci \u0161t\u011Bpu proti hostiteli (GVHD-graft versus host disease) zvy\u0161uj\u00EDc\u00ED mortalitu. Pr\u00E1ce se sna\u017E\u00ED shrnout sou\u010Dasn\u00FD pohled na celkov\u00FD v\u00FDznam HLA shody a interpretovat kvalitativn\u00ED a kvantitativn\u00ED efekt neshod v individu\u00E1ln\u00EDch HLA genech na v\u00FDsledek TKB od dosp\u011Bl\u00E9ho nep\u0159\u00EDbuzn\u00E9ho d\u00E1rce a to p\u0159edev\u0161\u00EDm u malign\u00EDch onemocn\u011Bn\u00ED. Standardem je v sou\u010Dasnosti snaha nal\u00E9zt d\u00E1rce alelicky shodn\u00E9ho minim\u00E1ln\u011B v HLA-A,-B,-C a-DRB1, proto\u017Ee izolovan\u00E1 neshoda v ka\u017Ed\u00E9m z t\u011Bchto gen\u016F zvy\u0161uje mortalitu o p\u0159ibli\u017En\u011B 10 % a v\u00EDce\u010Detn\u00E9 neshody maj\u00ED dokonce synergick\u00FD negativn\u00ED vliv. Efekt neshody je v\u0161ak v\u00FDznamn\u011B ovlivn\u011Bn stadiem z\u00E1kladn\u00EDho onemocn\u011Bn\u00ED, proto\u017Ee u vysoce rizikov\u00FDch nemocn\u00FDch je v d\u016Fsledku akcentovan\u00E9 GVL reakce mnohem m\u00E9n\u011B v\u00FDznamn\u00FD \u010Di dokonce zanedbateln\u00FD. S mo\u017Enou v\u00FDjimkou HLA-C lokusu u ransplantace perifern\u00EDmi krvetvorn\u00FDmi bu\u0148kami jsou neshody na alelick\u00E9 i antigenn\u00ED \u00FArovni z\u0159ejm\u011B srovnateln\u011B tolerovan\u00E9. Je-li nutn\u00E9 akceptovat neshodn\u00E9ho d\u00E1rce, pak u kostn\u00ED d\u0159en\u011B je l\u00E9pe vyhnout se neshod\u00E1m v HLA-A \u010Di DRB1, u perifern\u00EDch krvetvorn\u00FDch bun\u011Bk je nejh\u016F\u0159e tolerovanou %22antigenn\u00ED%22 neshoda v HLA-C. Mimo HLA shodu existuje cel\u00E1 \u0159ada faktor\u016F na stran\u011B d\u00E1rce, kter\u00E9 ovliv\u0148uj\u00ED v\u00FDsledek TKB a zde nutno zd\u016Fraznit p\u0159edev\u0161\u00EDm v\u010Dasnost proveden\u00ED transplantace, proto\u017Ee rychlost nalezen\u00ED nep\u0159\u00EDbuzn\u00E9ho d\u00E1rce a neprodlen\u00E9 proveden\u00ED TKB je tak\u0159ka stejn\u011B d\u016Fle\u017Eit\u00E9 jako stupe\u0148 shody." . . "6"^^ . "I" . . "1"^^ . . "CZ - \u010Cesk\u00E1 republika" . "Terapeutick\u00FD efekt nep\u0159\u00EDbuzensk\u00E9 transplantace krvetvorn\u00FDch bun\u011Bk (TKB) je nejv\u00EDce ur\u010Dov\u00E1n genetickou - HLA - neshodou mezi p\u0159\u00EDjemcem a d\u00E1rcem. Ta umo\u017E\u0148uje jak u malignit \u017E\u00E1douc\u00ED reakci \u0161t\u011Bpu proti leukemii (GVL - graft versus leukemia effect) sni\u017Euj\u00EDc\u00ED riziko relapsu, tak reakci \u0161t\u011Bpu proti hostiteli (GVHD-graft versus host disease) zvy\u0161uj\u00EDc\u00ED mortalitu. Pr\u00E1ce se sna\u017E\u00ED shrnout sou\u010Dasn\u00FD pohled na celkov\u00FD v\u00FDznam HLA shody a interpretovat kvalitativn\u00ED a kvantitativn\u00ED efekt neshod v individu\u00E1ln\u00EDch HLA genech na v\u00FDsledek TKB od dosp\u011Bl\u00E9ho nep\u0159\u00EDbuzn\u00E9ho d\u00E1rce a to p\u0159edev\u0161\u00EDm u malign\u00EDch onemocn\u011Bn\u00ED. Standardem je v sou\u010Dasnosti snaha nal\u00E9zt d\u00E1rce alelicky shodn\u00E9ho minim\u00E1ln\u011B v HLA-A,-B,-C a-DRB1, proto\u017Ee izolovan\u00E1 neshoda v ka\u017Ed\u00E9m z t\u011Bchto gen\u016F zvy\u0161uje mortalitu o p\u0159ibli\u017En\u011B 10 % a v\u00EDce\u010Detn\u00E9 neshody maj\u00ED dokonce synergick\u00FD negativn\u00ED vliv. Efekt neshody je v\u0161ak v\u00FDznamn\u011B ovlivn\u011Bn stadiem z\u00E1kladn\u00EDho onemocn\u011Bn\u00ED, proto\u017Ee u vysoce rizikov\u00FDch nemocn\u00FDch je v d\u016Fsledku akcentovan\u00E9 GVL reakce mnohem m\u00E9n\u011B v\u00FDznamn\u00FD \u010Di dokonce zanedbateln\u00FD. S mo\u017Enou v\u00FDjimkou HLA-C lokusu u ransplantace perifern\u00EDmi krvetvorn\u00FDmi bu\u0148kami jsou neshody na alelick\u00E9 i antigenn\u00ED \u00FArovni z\u0159ejm\u011B srovnateln\u011B tolerovan\u00E9. Je-li nutn\u00E9 akceptovat neshodn\u00E9ho d\u00E1rce, pak u kostn\u00ED d\u0159en\u011B je l\u00E9pe vyhnout se neshod\u00E1m v HLA-A \u010Di DRB1, u perifern\u00EDch krvetvorn\u00FDch bun\u011Bk je nejh\u016F\u0159e tolerovanou %22antigenn\u00ED%22 neshoda v HLA-C. Mimo HLA shodu existuje cel\u00E1 \u0159ada faktor\u016F na stran\u011B d\u00E1rce, kter\u00E9 ovliv\u0148uj\u00ED v\u00FDsledek TKB a zde nutno zd\u016Fraznit p\u0159edev\u0161\u00EDm v\u010Dasnost proveden\u00ED transplantace, proto\u017Ee rychlost nalezen\u00ED nep\u0159\u00EDbuzn\u00E9ho d\u00E1rce a neprodlen\u00E9 proveden\u00ED TKB je tak\u0159ka stejn\u011B d\u016Fle\u017Eit\u00E9 jako stupe\u0148 shody."@cs . "Praktick\u00FD pohled na v\u00FDznam HLA shody pro transplantaci krvetvorn\u00FDch bun\u011Bk od dosp\u011Bl\u00FDch nep\u0159\u00EDbuzn\u00FDch d\u00E1rc\u016F"@cs . "RIV/00669806:_____/13:10138998!RIV14-MZ0-00669806" . . "A practical view of the role of HLA matching in unrelated donor haematopoietic stem cell transplantation"@en . . "19" . . . "A practical view of the role of HLA matching in unrelated donor haematopoietic stem cell transplantation"@en . "Jindra, Pavel" .