Donor-specific anti-HLAAbs and graft failure in matched unrelated donor hematopoietic stem cell transplantation
Donor-specific anti-HLAAbs and graft failure in matched unrelated donor hematopoietic stem cell transplantation
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DOI：
10.1182/blood-2011-06-362111
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发表时间：
2011-11-24
期刊：
影响因子：
20.3
通讯作者：
Fernandez-Vina, Marcelo
中科院分区：
文献类型：
--
作者：
Ciurea, Stefan O.;Thall, Peter F.;Fernandez-Vina, Marcelo
据报道，抗 HLA 供体特异性抗体 (DSA) 与不匹配的造血干细胞移植中的移植失败有关。然而，它们在匹配无关供体（MUD）移植中移植失败的发生中的作用仍不清楚。我们假设针对不匹配的 HLA-DPB1 位点的 DSA 与这种情况下的移植失败有关。在固相荧光测定中使用混合筛选珠在 592 名 MUD 移植受者中前瞻性地确定了移植前抗 HLA 抗体的存在。使用含有相应供体 HLA 不匹配 Ag 的单 Ag 珠进行 DSA 鉴定。 116 名患者（19.6%）检测到抗 HLA 抗体，其中 20 名患者（3.4%）检测到抗 DPB1 抗体。总体而言，592 名患者中有 19 名 (3.2%) 发生移植失败，其中 584 名没有抗 HLA 抗体的患者中有 16 名 (2.7%) 发生移植失败，而 8 名有 DSA 的患者中有 3 名 (37.5%) (P = .0014)。在多变量分析中，DSA 是唯一与移植失败高度相关的因素（P = .0001；比值比 = 21.3）。女性的抗 HLA 异体过敏总体高于男性（30.8% vs 12.1%；P < .0001），并且妊娠 1 次 (P = .008) 和 2 次或以上 (P = .0003) 的女性高于男性。我们得出的结论是，抗 DPB1 DSA 的存在与 MUD 造血干细胞移植中的移植失败有关。 （血。2011；118(22):5957-5964）
Anti-HLA donor-specific Abs (DSAs) have been reported to be associated with graft failure in mismatched hematopoietic stem cell transplantation; however, their role in the development of graft failure in matched unrelated donor (MUD) transplantation remains unclear. We hypothesize that DSAs against a mismatched HLA-DPB1 locus is associated with graft failure in this setting. The presence of anti-HLA Abs before transplantation was determined prospectively in 592 MUD transplantation recipients using mixed-screen beads in a solid-phase fluorescent assay. DSA identification was performed using single-Ag beads containing the corresponding donor's HLA-mismatched Ags. Anti-HLA Abs were detected in 116 patients (19.6%), including 20 patients (3.4%) with anti-DPB1 Abs. Overall, graft failure occurred in 19 of 592 patients (3.2%), including 16 of 584 (2.7%) patients without anti-HLA Abs compared with 3 of 8 (37.5%) patients with DSA (P = .0014). In multivariate analysis, DSAs were the only factor highly associated with graft failure (P = .0001; odds ratio = 21.3). Anti-HLA allosensitization was higher overall in women than in men (30.8% vs 12.1%; P < .0001) and higher in women with 1 (P = .008) and 2 or more pregnancies (P = .0003) than in men. We conclude that the presence of anti-DPB1 DSAs is associated with graft failure in MUD hematopoietic stem cell transplantation. (Blood. 2011;118(22):5957-5964)