The MLC assay as a test for HLA-D region compatibility between patients and unrelated donors: results of a national marrow donor program involving multiple centers

Mixed lymphocyte culture (MLC) assays from 763 patients and prospective unrelated marrow transplant donors identified through the National Marrow Donor Program (NMDP) were analyzed for their overall utility in measuring HLA-D region compatibility. The assays were performed at 31 different transplant centers (range, 1 to 197; median, 9 assays per center). A total of 325/763 (42.6%) of the tests were judged to be uninterpretable, either due to lack of sufficient control cells included in the assay (89 tests) or to insufficient reactivity by patient and/or donor cells (236 tests). Among the 438 tests that could be interpreted, HLA-Dw phenotyping with HLA-D homozygous cells was performed for a subset of 190. The relative response (RR) values from these 190 tests, however, were not clearly separable into distinct populations; i.e., RR values corresponding to Dw identity versus nonidentity between patient and donor could not be reliably discriminated. The predictive value of a nonreactive MLC for Dw identity was calculated to be 0.91 for RRs of < or = 20%, while the predictive value of a reactive MLC for Dw nonidentity was 0.35 for RRs of > 20%. These results, based on an analysis of data submitted from multiple transplant centers testing patients who had a variety of hematologic disorders, suggest that the MLC assay is a relatively imprecise method for determining HLA-D region compatibility between patient and prospective unrelated marrow donor.