供者特异性抗 HLA 抗体对非亲缘性脐血移植后移植物失败和存活的影响：Eurocord、法国组织相容性和免疫遗传学学会（SFHI）和法国骨髓和细胞治疗移植学会（SFGM-TC）的分析。
Impact of donor-specific anti-HLA antibodies on graft failure and survival after reduced intensity conditioning-unrelated cord blood transplantation: a Eurocord, Société Francophone d'Histocompatibilité et d'Immunogénétique (SFHI) and Société Française de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC) analysis.
机构信息
Eurocord, Hôpital Saint Louis APHP, University Paris VII IUH Paris, France.
出版信息
Haematologica. 2013 Jul;98(7):1154-60. doi: 10.3324/haematol.2012.077685. Epub 2012 Dec 14.
Graft failure is a major complication after unrelated cord blood transplantation. Presence of HLA-antibodies before cord blood transplantation may impact graft failure. To analyze the effect of anti-HLA antibodies on unrelated cord blood transplantation outcomes, we analyzed 294 unrelated cord blood transplant recipients after reduced intensity conditioning regimen. The majority of the patients (82%) were transplanted for malignancies, 60% with double-unrelated cord blood transplant, 63% were HLA mismatched. Retrospectively, pre-unrelated cord blood transplant serum was tested for HLA-Ab using Luminex™ platform. Results were interpreted as mean fluorescence intensity (MFI) against donor-specific mismatch. Among 62 recipients (23%) who had anti-HLA antibodies before unrelated cord blood transplant, 14 patients had donor specific anti-HLA antibodies (DSA) (7 were donor-specific anti-HLA antibodies for single unrelated cord blood transplant and 7 for double unrelated cord blood transplant). Donor specific anti-HLA antibodies threshold ranged from 1620-17629 of mean fluorescence intensity (MFI). Cumulative incidence of Day-60 neutrophil engraftment was 76%: 44% for recipients with donor specific anti-HLA antibodies and 81% in those without donor specific anti-HLA antibodies (P=0.006). The cumulative incidence of 1-year transplant related mortality was 46% in patients with donor specific anti-HLA antibodies and 32% in those without antibodies (P=0.06). The presence of donor specific anti-HLA antibodies was associated with a trend for decreased survival rate (42% vs. 29%; P=0.07). Donor specific anti-HLA antibody in recipients of unrelated cord blood transplant is associated with graft failure and decreased survival. Patient's screening for donor specific anti-HLA antibodies before unrelated cord blood transplantation is recommended before choosing an HLA mismatched cord blood unit. Whenever possible it is important to avoid selecting a unit for which the patient has donor specific anti-HLA antibodies.
移植物失败是无关脐带血移植后的主要并发症。脐带血移植前存在 HLA 抗体可能会影响移植物失败。为了分析抗 HLA 抗体对无关脐带血移植结果的影响，我们分析了 294 例接受低强度预处理方案的无关脐带血移植受者。大多数患者（82%）因恶性肿瘤接受移植，60%接受双份无关脐带血移植，63%存在 HLA 错配。回顾性地，使用 Luminex™平台检测无关脐带血移植前血清中的 HLA-Ab。结果以与供体特异性错配的平均荧光强度（MFI）表示。在 62 例（23%）接受无关脐带血移植前有抗 HLA 抗体的受者中，14 例有供体特异性抗 HLA 抗体（DSA）（7 例为单份无关脐带血移植的供体特异性抗 HLA 抗体，7 例为双份无关脐带血移植的供体特异性抗 HLA 抗体）。供体特异性抗 HLA 抗体的阈值范围为 1620-17629 平均荧光强度（MFI）。第 60 天中性粒细胞植入的累积发生率为 76%：有供体特异性抗 HLA 抗体的受者为 44%，无供体特异性抗 HLA 抗体的受者为 81%（P=0.006）。有供体特异性抗 HLA 抗体的患者 1 年移植相关死亡率为 46%，无抗体的患者为 32%（P=0.06）。供体特异性抗 HLA 抗体与生存率降低呈趋势相关（42%比 29%；P=0.07）。无关脐带血移植受者的供体特异性抗 HLA 抗体与移植物失败和生存率降低有关。建议在选择 HLA 错配脐带血单位之前对无关脐带血移植患者进行供体特异性抗 HLA 抗体筛查。在可能的情况下，重要的是要避免选择患者具有供体特异性抗 HLA 抗体的单位。
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