Dahi Parastoo B, Barone Jonathan, Devlin Sean M, Byam Courtney, Lubin Marissa, Ponce Doris M, Giralt Sergio, Kernan Nancy A, Scaradavou Andromachi, Hsu Susan H, Barker Juliet N
Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.
Department of Histocompatibility/Molecular Genetics, American Red Cross Blood Services/Penn Jersey Region, Philadelphia, Pennsylvania.
Biol Blood Marrow Transplant. 2014 May;20(5):735-9. doi: 10.1016/j.bbmt.2014.01.017. Epub 2014 Jan 23.
The impact of human leukocyte antigen (HLA) donor-specific antibodies (DSA) on cord blood (CB) engraftment is controversial. We evaluated the influence of pre-existing HLA-antibodies (HLA-Abs) on engraftment in 82 double-unit CB recipients (median age, 48 years) who underwent transplantation for hematologic malignancies. Of 28 patients (34%) with HLA-Abs, 12 had DSA (median mean fluorescence intensity 5255; range, 1057 to 9453). DSA patients had acute leukemia (n = 11) or myelodysplasia (n = 1) and all received either high-dose or reduced-intensity (but myeloablative) conditioning. After myeloablative CB transplantation (CBT) (n = 67), sustained donor engraftment was observed in 95% without HLA-Abs (median, 23 days), 100% with nonspecific HLA-Abs (median, 23 days), and 92% with DSA (median, 31 days, P = .48). Of 6 patients with HLA-Abs to 1 unit, 3 engrafted with that unit and 3 with the other. Of 6 patients with HLA-Abs against both units, 1 had graft failure despite being 100% donor, and 5 engrafted with 1 unit. Successful donor engraftment is possible in patients with DSA after myeloablative double-unit CBT. Our data suggest potential deleterious effects of DSA can be abrogated in patients with hematologic malignancies.
人类白细胞抗原（HLA）供者特异性抗体（DSA）对脐血（CB）植入的影响存在争议。我们评估了82例接受血液系统恶性肿瘤移植的双单位CB受者（中位年龄48岁）中预先存在的HLA抗体（HLA-Abs）对植入的影响。在28例（34%）有HLA-Abs的患者中，12例有DSA（中位平均荧光强度5255；范围1057至9453）。DSA患者患有急性白血病（n = 11）或骨髓增生异常综合征（n = 1），均接受了大剂量或减低强度（但为清髓性）预处理。在进行清髓性脐血移植（CBT）（n = 67）后，无HLA-Abs的患者中有95%观察到持续的供者植入（中位时间23天），有非特异性HLA-Abs的患者中有100%（中位时间23天），有DSA的患者中有92%（中位时间31天，P = 0.48）。在6例对1个单位有HLA-Abs的患者中，3例植入了该单位，3例植入了另一个单位。在6例对两个单位都有HLA-Abs的患者中，1例尽管100%为供者仍发生移植失败，5例植入了1个单位。清髓性双单位CBT后，有DSA的患者有可能成功实现供者植入。我们的数据表明，血液系统恶性肿瘤患者中DSA的潜在有害影响可以被消除。
