Blood and Marrow Transplantation Program, University of Minnesota, 420 Delaware Street, Minneapolis, MN 55455, USA.
Biol Blood Marrow Transplant. 2011 Nov;17(11):1704-8. doi: 10.1016/j.bbmt.2011.04.013. Epub 2011 May 3.
Recent registry data suggest that host-versus-graft alloreactions mediated by anti-donor HLA antibodies in recipients of adult allogeneic hematopoietic stem cells or single-unit umbilical cord blood (UCB) contribute to the risk of graft failure. The present study evaluated the impact of anti-HLA antibodies on engraftment and unit predominance in 126 double-UCB (dUCB) recipients. Eighteen dUCB recipients were identified with at least 1 of 2 UCB units recognized by anti-HLA antibodies directed against donor-directed HLA-specific antibodies (DSAs). Overall, 9 of 12 patients who had DSAs against 1 of the 2 UCB units composing the graft and 5 of 6 patients who had DSAs against both units engrafted. The cumulative incidence of engraftment was similar in patients with and without DSAs (83% vs 78%). Thus, our data do not support a negative effect of anti-HLA antibodies on engraftment, at least in the setting of cyclosporine and mycophenolate mofetil and the conditioning regimens used at the University of Minnesota, and argue against routine screening for use in graft selection before dUCB transplantation. Further studies are needed to fully understand the value of anti-HLA antibody testing in dUCB graft selection and its impact on transplantation outcomes.
最近的登记数据表明，受者体内针对供者 HLA 抗体的同种异体移植物抗宿主反应是导致成体异基因造血干细胞或单份脐带血 (UCB) 移植失败的风险因素。本研究评估了抗 HLA 抗体对 126 例双份 UCB（dUCB）受者植入和单位优势的影响。18 例 dUCB 受者的 2 个 UCB 单位中至少有 1 个被针对供者 HLA 特异性抗体的抗 HLA 抗体识别。总的来说，9 例患者的移植物中存在针对 2 个 UCB 单位之一的 DSAs，其中 5 例患者针对两个单位均发生了植入。有和没有 DSAs 的患者的植入累积发生率相似（83%与 78%）。因此，我们的数据不支持抗 HLA 抗体对植入的负面影响，至少在环孢素和吗替麦考酚酯以及明尼苏达大学使用的预处理方案的情况下是如此，并且反对在进行 dUCB 移植前常规进行抗 HLA 抗体筛查以用于移植物选择。需要进一步的研究来全面了解抗 HLA 抗体检测在 dUCB 移植物选择中的价值及其对移植结局的影响。
