Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
Blood. 2011 Nov 24;118(22):5957-64. doi: 10.1182/blood-2011-06-362111. Epub 2011 Oct 3.
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.
抗 HLA 供体特异性抗体（DSA）已被报道与不合型造血干细胞移植中的移植物失功有关；然而，其在匹配的无关供体（MUD）移植中导致移植物失功的作用仍不清楚。我们假设针对错配 HLA-DPB1 位点的 DSA 与此种情况下的移植物失功有关。在 592 例 MUD 移植受者中，使用固相荧光检测法中的混合珠，前瞻性地检测了移植前抗 HLA Abs 的存在情况。使用含有相应供体 HLA 错配抗原的单抗原珠进行 DSA 鉴定。在 116 例患者（19.6%）中检测到抗 HLA Abs，包括 20 例（3.4%）抗 DPB1 Abs 患者。总的来说，在 592 例患者中有 19 例（3.2%）发生移植物失功，其中 584 例无抗 HLA Abs 的患者中有 16 例（2.7%）发生移植物失功，而 8 例有 DSA 的患者中有 3 例（37.5%）发生移植物失功（P =.0014）。在多变量分析中，DSA 是唯一与移植物失功高度相关的因素（P =.0001；优势比=21.3）。总的来说，女性的抗 HLA 同种致敏率高于男性（30.8%比 12.1%；P<0.0001），且 1 次（P =.008）和 2 次或以上妊娠（P =.0003）的女性高于男性。我们得出结论，抗 DPB1 DSA 的存在与 MUD 造血干细胞移植中的移植物失功有关。
