The detection of donor-directed, HLA-specific alloantibodies in recipients of unrelated hematopoietic cell transplantation is predictive of graft failure
The detection of donor-directed, HLA-specific alloantibodies in recipients of unrelated hematopoietic cell transplantation is predictive of graft failure
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DOI：
10.1182/blood-2009-09-244525
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发表时间：
2010-04-01
期刊：
影响因子：
20.3
通讯作者：
Anasetti, Claudio
中科院分区：
文献类型：
--
作者：
Spellman, Stephen;Bray, Robert;Anasetti, Claudio
在造血干细胞移植（HCT）动物模型中，供体导向的人白细胞抗原（HLA）特异性同种异体抗体（dsa）导致移植物失败。我们对移植失败患者（n = 37）和匹配病例对照队列（n = 78）的移植前血清进行了检测，以评估dsa在非亲属供体HCT中的作用。对照组根据疾病、疾病状态、移植物类型、患者年龄和移植年份进行匹配。患者患有急性髓性白血病、急性淋巴细胞白血病、慢性髓性白血病或骨髓增生异常综合征；98%接受了骨髓清除调理方案，100%接受了t-填充移植，97%接受了骨髓，95%接受了hla错配，97%接受了基于钙调磷酸酶的移植物抗宿主病预防。在37例失败的移植中，9例（24%）受者对HLA-A、B和/或DP有dsa，而78例对照中只有1例（1%）。因此，dsa的存在与移植物失败显著相关（优势比为22.84；95%可信区间为3.57-无穷大；P < 0.001）。这些结果表明，非亲属供体HCT受者移植前dsa的存在与移植失败有关，在选择HCT供体时应予以考虑。(血。2010;115 (13):2704 - 2708)
Donor-directed human leukocyte antigen (HLA)-specific allo-antibodies (DSAs) cause graft failure in animal models of hematopoietic stem cell transplantation (HCT). Archived pretransplantation sera from graft failure patients (n = 37) and a matched case-control cohort (n = 78) were tested to evaluate the role of DSAs in unrelated donor HCT. Controls were matched for disease, disease status, graft type, patient age, and transplantation year. Patients had acute myeloid leukemia, acute lymphoblastic leukemia, chronic myelogenous leukemia, or myelodysplastic syndrome; 98% received myeloablative conditioning regimens 100% received T-replete grafts, 97% received marrow, 95% HLA-mismatched, and 97% received calcineurin-based graft-versus-host disease prophylaxis. Among the 37 failed transplantations, 9 ( 24%) recipients possessed DSAs against HLA-A, B, and/or DP, compared with only 1 (1%) of 78 controls. Therefore, the presence of DSAs was significantly associated with graft failure (odds ratio = 22.84; 95% confidence interval, 3.57-infinity; P < .001). These results indicate that the presence of pretransplantation DSAs in recipients of unrelated donor HCT is associated with failed engraftment and should be considered in HCT donor selection. (Blood. 2010;115(13):2704-2708)