Preimplantation Genetic Testing for HLA Matching (PGT-HLA) When Only Partial Embryo Matches are Identified

Abstract

Introduction: Preimplantation Genetic Testing (PGT) is an option for couples to select embryos that have a matching Human Leukocyte Antigen (HLA) type to a child that is in need of hematopoietic stem cell transplant (HSCT). Families in search of HLA-matched donors for HSCT may have a difficult time finding publicly available optimal donors or donors within their families. The likelihood of a family finding an optimal donor can vary from 16% to 75%, depending on ethnic and racial groups. Previously, PGT-HLA has been used to identify potential future siblings who would be an HLA match to an affected child through embryo testing as early as 2001 for conditions like Fanconi Anemia. PGT-HLA can be complicated by the presence of recombination within the HLA complex on chromosome 6 in the affected individual. If an affected child is found to be recombinant within the HLA complex (6-7% of PGT-HLA cases), the chances of finding a full sibling-matched donor can be extremely low. PGT for partial HLA matching can be used when the affected child is found to be recombinant or if a full parental match is not possible. When a child is identified as recombinant in the HLA region, consultation with their transplant team can determine whether a partial sibling match would be a good therapeutic candidate. PGT-HLA is performed by linkage analysis which requires DNA samples from the oocyte source, sperm source, and the affected child. These results will determine shared parental regions of the HLA complex genes so that partial matches can be identified. Case Reviews: We present two cases of PGT-HLA where only partial matches were identified during embryo testing. Of these 2 cases, both families completed one testing cycle for PGT-M and PGT-HLA and both had partial matches that were recommended for transfer per patient consent. One family had 3 partial match embryos, but they did not have a successful pregnancy following frozen embryo transfer. However, during the period of their transfers, they were able to find an adequate publicly-matched donor for HSCT therapy for their child. In one family, only a paternal HLA match was sought due to advanced maternal age of the mother. Consultation with the family’s transplant team indicated that a paternal-only match would be sufficient for a therapeutic effect. Conclusions: Despite the complexity of testing for PGT-HLA matching for a child where a full sibling match is not available embryo testing can still provide a therapeutic benefit. Interdisciplinary consultation in these cases would optimally include the couple, the affected child’s transplant team, the couple’s reproductive endocrinologist, and genetic counseling available at the PGT laboratory or the REI office. As accessibility to PGT continues to grow and as guidelines for PGT acceptability continue to be written, PGT-HLA should similarly find more usage. Inevitably, partial embryo matches will be seen and we will continue to learn how these can be used in clinical practice.