Department of Medical Oncology, Division of Hematological Malignancies, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02115, USA.
Blood. 2011 Dec 15;118(25):6691-7. doi: 10.1182/blood-2011-05-355263. Epub 2011 Sep 22.
Using a uniform detection method for donor-specific anti-HLA antibodies (DSAs), we sought to determine the effect of preformed DSAs on outcomes in double umbilical cord blood transplantation. DSAs were associated with an increased incidence of graft failure (5.5% vs 18.2% vs 57.1% for none, single, or dual DSA positivity; P = .0001), prolongation of the time to neutrophil engraftment (21 vs 29 days for none vs any DSA; P = .04), and excess 100-day mortality or relapse (23.6% vs 36.4% vs 71.4% for none, single, or dual DSA positivity; P = .01). The intensity of DSA reactivity was correlated with graft failure (median of mean fluorescent intensity 17 650 vs 1 850; P = .039). There was inferior long-term progression-free and overall survival when comparing patients with DSAs against both umbilical cord blood units to those without DSAs (3-year progression-free survival, 0% vs 33.5%, P = .004; 3-year overall survival 0% vs 45.0%, P = .04). We conclude that identification of preformed DSAs in umbilical cord blood recipients should be performed and that the use of umbilical cord blood units where preformed host DSAs exist should be avoided.
我们采用统一的方法检测供者特异性抗 HLA 抗体（DSA），旨在探讨预先存在的 DSA 对双脐血移植结局的影响。DSA 与移植物失功发生率增加相关（无、单阳性或双阳性 DSA 的发生率分别为 5.5%、18.2%和 57.1%；P=0.0001），中性粒细胞植入时间延长（无 DSA 与任何 DSA 的时间分别为 21 天和 29 天；P=0.04），100 天死亡率或复发率增加（无、单阳性或双阳性 DSA 的发生率分别为 23.6%、36.4%和 71.4%；P=0.01）。DSA 反应强度与移植物失功相关（平均荧光强度中位数 17650 比 1850；P=0.039）。与无 DSA 的患者相比，同时比较具有 DSA 的患者与两个脐血单位，发现其长期无进展生存率和总生存率均较低（3 年无进展生存率，0%比 33.5%，P=0.004；3 年总生存率，0%比 45.0%，P=0.04）。我们的结论是，应在脐血受者中进行预先存在的 DSA 检测，并避免使用存在预先形成的宿主 DSA 的脐血单位。
