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Dear Editor,

In HLA matching and the selection of donors for bone marrow transplantation, CPD Bulletin, Immunology and Allergy 1999; 1(2): 4750, Margaret Little and Paul Sinnott present a review article. Although their review of HLA serological and DNA typing is excellent, I am disappointed that they make no reference to functional tests in the selection of unrelated donors. Although the ideal unrelated donor is one who is matched by high resolution typing for every single allele, the situation can and does arise where a minimal degree of mismatching can be detected (eg equivalent to one amino acid difference between patient and donor). The only way to determine the significance of such a mismatch is by a functional test ( ie CTLp or HTLp analysis).

Sincerely,

Reply to Dr Kaminski

Cellular assays such as CTLp HTLp and MLC have been, and still are, utilised to determine compatibility between donor and patient in some centres. However, such tests are not considered mandatory and for this reason were not included in our review. Dr. Kaminiskis statement regarding the use of CTLp and HTLp assays to determine the functional significance of a single amino acid difference suggests that these assays could be utilised to determine the optimum donor where a choice of donors is available. The reality of bone marrow donor selection procedures is that it is rare to have such a luxury of finding more than one compatible donor (in terms of HLA matching, virology and gender). Cellular assays clearly have some role in determining compatibility, but the variation in methodologies utilised between laboratories, and controversy over interpretation of these tests in the literature suggests that this subject alone be the topic for a CPD article.

Sincerely,