Japanese Red Cross Tokyo Blood Center, Tokyo, Japan.
Blood. 2010 Oct 14;116(15):2839-46. doi: 10.1182/blood-2009-10-249219. Epub 2010 Jul 13.
The majority of cord blood transplantations (CBTs) have human leukocyte antigen (HLA) disparities. We investigated the impact that patients' pretransplantation anti-HLA antibodies have on the outcome of CBTs. Testing for anti-HLA antibody and its specificity was performed retrospectively at the Japanese Red Cross Tokyo Blood Center with sensitive solid-phase antibody detection assays. Among 386 CBTs, which were first myeloablative stem cell transplantations for malignancies and used a single unit of cord blood, 89 tested positive. Among the antibody-positive group, the cord blood did not have the corresponding HLA type for the antibody in 69 cases (ab-positive), while 20 cases had specificity against the cord blood HLA (positive-vs-CB). Cumulative incidence of neutrophil recovery 60 days after transplantation was 83% (95% confidence interval [CI], 79%-87%) for the antibody-negative group (ab-negative), 73% (95% CI, 61%-82%) for ab-positive, but only 32% (95% CI, 13%-53%) for the positive-vs-CB (P < .0001, Gray test). With multivariate analysis, the ab-positive showed significantly lower neutrophil recovery than the ab-negative (relative risk [RR] = 0.69, 95% CI, 0.49-0.96, p = .027). The positive-vs-CB had significantly lower neutrophil recovery (RR = 0.23, 95% CI, 0.09-0.56, P = .001) and platelet recovery (RR = 0.31, 95% CI, 0.12-0.81, P = .017) than the ab-negative. Patients' pretransplantation anti-HLA antibodies should be tested and considered in the selection of cord blood.
大多数脐血移植（CBT）存在人类白细胞抗原（HLA）差异。我们研究了患者移植前抗 HLA 抗体对 CBT 结果的影响。在日本红十字会东京血液中心，使用敏感固相抗体检测法对 HLA 抗体及其特异性进行回顾性检测。在 386 例首次用于恶性肿瘤的单一单位脐血的清髓性干细胞移植中，89 例呈阳性。在抗体阳性组中，69 例（ab 阳性）的脐血与抗体无相应的 HLA 型，而 20 例对脐血 HLA 具有特异性（阳性对 CB）。移植后 60 天中性粒细胞恢复的累积发生率在抗体阴性组（ab-阴性）为 83%（95%置信区间 [CI]，79%-87%），ab 阳性组为 73%（95% CI，61%-82%），但阳性对 CB 组仅为 32%（95% CI，13%-53%）（P<.0001，Gray 检验）。多变量分析显示，ab 阳性组中性粒细胞恢复明显低于 ab 阴性组（相对风险 [RR] = 0.69，95%CI，0.49-0.96，p =.027）。阳性对 CB 组中性粒细胞恢复（RR = 0.23，95%CI，0.09-0.56，P =.001）和血小板恢复（RR = 0.31，95%CI，0.12-0.81，P =.017）明显低于 ab 阴性组。应检测和考虑患者移植前的抗 HLA 抗体，以选择脐血。
