Completing the CIBMTR Confirmation of HLA Typing Form (Form 2005)

Transcription

1 Completing the CIBMTR Confirmation of HLA Typing Form (Form 2005) Stephen Spellman Research Manager NMDP Scientific Services Maria Brown Scientific Services Specialist Data Management Conference

2 Introduction to Form 2005 Basic Biology of HLA Overview of HLA nomenclature Laboratory report interpretation and data transcription 2

3 Introduction The CIBMTR product information is collected on three separate forms: The IDM form (Form 2004) The Confirmation of HLA Typing form (Form 2005) Infusion form (Form 2006) HLA form modeled on NMDP Form 22/117 3

4 Confirmation of HLA Typing Form The Confirmation of HLA Typing form is completed for: Non-NMDP allogeneic or syngeneic donors Non-NMDP recipients Non-NMDP cord blood units Complete a separate copy of this form for each donor, recipient, or cord blood unit Not required on NMDP-facilitated transplants! 4

5 FormsNet 2.0 All data fields identical to the paper form 5

6 Basic Biology of HLA 6

7 What is HLA? Human Leukocyte Antigen (HLA) First discovered through antigenic differences on white blood cells Highest expressed antigens are the class I and class II HLA molecules (0.5-1 million per cell) 7

8 HLA and the MHC HLA is part of a larger system know as the Major Histocompatibility Complex (MHC) MHC is a set of closely linked genes inherited as a unit (complex) MHC was initially recognized by its major influence on transplant rejection 8

9 Histocompatibility Molecules MHC is divided into two main regions: HLA class I HLA class II Encoded by genes on chromosome 6 9

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11 HLA Inheritance HLA genes on the same haplotype are inherited together, along with the rest of the MHC Complex HLA Class II HLA Class I C DRB1 DQB1 B C A Maternal Copy C DRB1 DQB1 B C A Paternal Copy 11

12 HLA Inheritance a c 25% FATHER MOTHER a b c d A B DR O F F S P R I N G a d b c b d 25% 25% 25% b/a d Recombinant Sibling (1%) 12

13 HLA Diversity Highest degree of polymorphism in human genome The diversity makes possible thousands of different combinations 13

14 HLA Typing Methods Serology Identifies HLA molecules on the cell surface using antigen specific anti-sera DNA Protein Antigen DNA Identifies HLA molecules by defining the DNA code in the cell nucleus 14

15 HLA Nomenclature DNA Serology DNA Serology A*0201 A2 A*0202 A2 A*0203 A2 A*0204 A2 A*0205 A2.. A*0273 A2 15

16 Number of Antigens/Alleles 16

17 Why So Diverse? Present many different types of peptides Protection from a myriad of pathogens 17

18 The Function of HLA Molecules Present antigen (peptides) to T-lymphocytes Facilitate immune surveillance Detection of: Viral or bacterial infected cells Mutated genes or proteins 18

19 Class I HLA Molecules Co-dominantly expressed on the surface of almost all nucleated cells (except RBCs and CNS) Present intracellular peptides to CD8 + T cells Individuals express up to 6 different class I molecules; two HLA-A, two HLA-B and two HLA-C 19

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21 Class II HLA Molecules Expressed on the surface of Antigen Presenting Cells (APCs) B lymphocytes, dendritic cells and thymic epithelial cells Class II HLA-DRB1/3/4/5, DQA1, DQB1, DPA1, DPB1 Present extracellular (and intracellular) peptides to CD4+ T cells Consist of a and b chains 21

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23 HLA Class I and II Antigen Presenting Cell Groove-Domain TM Cytoplasmic Class I Class II 1 Exon 2 Exon 3 Exon Exon 2 Exon

24 HLA Class I and II Peptide Antigen Presenting Cell Groove-Domain TM Cytoplasmic Class I Class II 1 Exon 2 Exon 3 Exon Exon 2 Exon

25 HLA Class I and II T Cell Antigen Presenting Cell Groove-Domain TM Cytoplasmic Class I Class II 1 Exon 2 Exon 3 Exon Exon 2 Exon

26 HLA and Transplantation Stem cell transplantation is transplanting of the immune system Graft rejection occurs when the residual host immune system attacks the transplanted immune system Graft vs. Host Disease (GvHD) occurs when the new immune system begins to attack the body of the recipient 26

27 HLA Basic Biology - Summary HLA genes part of MHC complex Inherited as maternal and paternal haplotypes HLA genes are the most polymorphic in the human genome Facilitate immune surveillance Present self and non-self peptides (viral, bacterial, mutated proteins, etc ) to circulating T cells 27

28 Overview of HLA Nomenclature 28

29 Examples of Serological Typing Nomenclature A10 B15 DR4 A2 B35 DR15 gene order of antigen discovery 29

30 Examples of DNA Typing Nomenclature A*2501 B*1503 DRB1*0402 gene A*0210 B*3502 DRB1*1504 * DNA methodology order of allele discovery allele group structure serologic 30

31 DNA Nomenclature: Silent Substitutions Example: DRB1*1502 DRB1* DRB1* DRB1* DRB1* The fifth & sixth digits indicate a difference in DNA structure, but the HLA antigens specified do not differ 31

32 DNA Nomenclature Oddities A* = Silent mutation A*2409N = (Null) No antigen expressed A*2402L = Low antigen expression B*4402S = HLA protein is secreted B*3565Q = Antigen level is questionable Antigen 32

33 NMDP Allele Codes 01DD 15AAA 11AAF 02EF 13EG 04FH 01BAB 01FG 01TY 13ST 01AG 13ADG 01AD 11AKA 01DD 01TY 02GS 04FH 01PP 07XX 03HJ 33

34 NMDP Allele Codes used for Multiple Allele Designations Used to report multiple possible alleles (intermediate/high resolution) Provides maximum information on the person s typing NMDP Bioinformatics Web site contains look-up Web tool 34

35 NMDP Codes for Multiple Allele Designation AB = 01/02 A*0201 or *0202 = A*02AB B*4001 or *4002 = B*40AB DRB1*1501 or *1502 = DRB1*15AB 35

36 CIBMTR Confirmation of HLA Typing Form (Form 2005) 36

37 Key Fields Box The Key Fields Box contains information about the transplant recipient, donor, cord, transplant date and type of transplant. The Key Fields link the donor forms to the patient forms. 37

38 Key Fields Box The section on the bottom of Page 5 is used if multiple donors or cords were infused into one recipient. 38

39 Whose HLA typing data are you reporting? 39

40 Are you submitting a laboratory report? If you have any questions about how to interpret a lab report, please contact either: Maria Brown 612/ mbrown2@nmdp.org Steve Spellman 612/ sspellma@nmdp.org 40

41 Transcribing HLA Typing Data from Laboratory Reports 41

42 Is it Serology or DNA? Serology Lymphotoxicity Microlymphotoxicity Serology Luminex Molecular PCR PCR-SSP SBT SSO SSOP DNA DNA 42

43 General Instructions DNA Typing One possible allele in each set of boxes Use as many boxes as you have alleles to report If more than six possible alleles, fill the boxes provided then write the remainder of the alleles in the available space on the page, clearly indicating the appropriate locus 43

44 How to Read a Lab Report / is used to separate alleles (example DRB1*0701/03 equals 0701 or 0703) - is used to indicate a range of alleles (example B* equals 0801/0802/0803) 44

45 DNA-Based Typing in FormsNet HLA Laboratory Report The HLA field in FormsNet supports up to 250 characters 0201/09/43N/66/75/83N/ /01N/20/21N 0702/

46 DNA-Based Typing HLA Laboratory Report N 2 1 N A* N N Notice that the 02 is in front of the A*

47 Which Typing do I Use? Patient Donor Remember to check the comments or footnotes on your laboratory report. There is often further clarification of the HLA typing. A* / /

48 What About Laboratory Report A#1 A#2 B#1 B#2 DR#1 DR#2 Cw#1 Cw#2 *0201 *3201 *0702 *0801 *0301 *1101 *0702 DQ#1 DQ#2 DRB345#1 DRB345#2 *0201 *0301 = C*0701/0706/0718 NT = Not Tested Enter the alpha/numeric data from the footnote on the forms and/or into FormsNet 2.0. Please note that without the key we cannot decipher your symbols. 48

49 Reporting NMDP Allele Codes Directly transcribe any allele codes onto the form or into FormsNet. 02ANGA 03XKS 0 2 A N G A 0 3 X K S AMUT A M U T 05AC A C FormsNet Paper form 49

50 What to do with Positives?? Example P o s 0 5 R V 0 6 B V AH Either write or type positive or pos Please do not use + or - 50

51 Serologic Typing and DNA? ENTER BOTH! CUMULATIVE HLA TYPE RESULTS HLA Class I Antigens HLA Class II Antigens A B Cw DR DR51/52/53 DQ A1 A24 B8 B35 Cw4 Cw7 DR1 DR17 DQ2 DQ5 Serology MOLECULAR TYPING BY PCR-SSP, SBT AND/OR LUMINEX SSO DNA HLA -A HLA -B HLA -Cw HLA-DPB1 A*0101 B*0801 Cw*0401 A*2402 B*3501 Cw*0701 HLA DRB1 HLA DRB3/4/5 HLA DQB1 DRB1*0101 DQB1*0201 DRB1*0301 DQB1*

52 Serology in FormsNet 2.0 Drop down selection menu Yes/No buttons

53 Example Laboratory Reports for Completing Form: Confirmation of HLA Typing Form (Form 2005) 53

54 Example A 54

55 Example A continued 2 9 X X 2 4 X X 0 7 X X X X Positive 55

56 Example B 56

57 Example B continued

58 Example C 58

59 Example C continued

60 Example D 60

61 Example D continued / / /

62 Example E

63 Example E continued

64 Summary Form 2005 required on non-nmdp donors and recipients Multiple donors = multiple forms Transcribe data directly as reported on laboratory report* Include all possible alleles for DNA-based typing Report both DNA and Serology data, if available *Remember to watch for footnotes 64

65 Please remember: If you have any questions about how to interpret a lab report, please contact either: Maria Brown 612/ mbrown2@nmdp.org Steve Spellman 612/ sspellma@nmdp.org 65