Benchmarking of 5 algorithms for high-resolution genotyping of human leukocyte antigen class I genes from blood and tissue samples br

Background: Specific alterations in human leukocyte antigen class I (HLA-I) loci are associated with clinical outcomes for immune checkpoint inhibitors, which increases the clinical relevance of accurate high-resolution HLA genotyping in immuno-oncology applications. Numerous algorithms have been developed for high- to full-resolution HLA genotyping by next-generation sequencing (NGS) data; however, Sanger sequencing-based typing (SBT) remains the gold standard. With the increasing use of NGS for clinical oncology, it is important to identify the computational tool with comparable performance as the gold standard. This study aimed to benchmark 5 algorithms against SBT for the high-resolution typing of classical HLA-I genes for targeted NGS data from blood and tissue samples. Methods: Paired white blood cell (WBC), plasma, and tissue deoxyribonucleic acid (DNA) samples derived from 22 cancer patients with known HLA genotypes were sequenced using a panel of all the following exons of classical HLA-I genes: HLA-A, HLA-B, and HLA-C. NGS-based genotypes were generated by the 5 different algorithms, including HLA-HD, HLAscan, OptiType, Polysolver, and xHLA. Accuracy was defined as the concordance between the SBT and NGS-based algorithms. Accuracy was computed as the fraction of all the alleles with concordant genotype using the SBT and any of the algorithm over the total number of alleles. Results: In relation to the WBC, plasma, and tissue samples, all 5 algorithms were highly accurate at low-resolution HLA-I genotyping, but had more varied accuracy at high-resolution HLA-I genotyping, particularly in HLA-A. The in-silico analyses revealed that high-resolution genotyping by all 5 algorithms achieved approximately 90% accuracy at sequencing depths of 6,000x - 100x for the WBC samples, at 6,000x - 700x for the plasma samples, and at 1,000x - 100x for the tissue samples. Among the 5 algorithms, HLA-HD was consistently accurate at high-resolution HLA-I genotyping, and had an accuracy of 93.9% for the WBC samples, 87.9% for the plasma samples, and 94.2% for tissue samples even at a 50x sequencing depth. Conclusions: We found that HLA-HD was an accurate algorithm for the high-resolution genotyping of classical HLA-I genes sequenced by our targeted panel, particularly at a sequencing depth >= 300x for blood and tissue samples