Yamamoto Hisashi, Uchida Naoyuki, Matsuno Naofumi, Ota Hikari, Kageyama Kosei, Wada Sachie, Kaji Daisuke, Nishida Aya, Ishiwata Kazuya, Takagi Shinsuke, Tsuji Masanori, Asano-Mori Yuki, Yamamoto Go, Izutsu Koji, Masuoka Kazuhiro, Wake Atsushi, Yoneyama Akiko, Makino Shigeyoshi, Taniguchi Shuichi
Department of Hematology, Toranomon Hospital, Tokyo, Japan.
Department of Hematology, Toranomon Hospital, Tokyo, Japan; Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
Biol Blood Marrow Transplant. 2014 Oct;20(10):1634-40. doi: 10.1016/j.bbmt.2014.06.024. Epub 2014 Jun 24.
The impact of anti-HLA antibodies, except for donor-specific anti-HLA-A, -B, -DRB1 antibodies, on engraftment was retrospectively evaluated in 175 single cord blood transplantations (CBT). Patients and donors had been typed at HLA-A, -B, and -DRB1 antigens, and anti-HLA antibodies had been screened before transplantation to avoid the use of cord blood (CB) units with corresponding antigens. The median age was 59 (range, 17 to 74) years. Overall, 61% were male, 89% had high-risk disease status, 77% received myeloablative conditioning regimens, and over 80% were heavily transfused patients. Sixty-nine of the 175 (39.4%) were positive for anti-HLA antibodies. Thirty-nine patients had antibodies only against HLA-A, -B, or -DRB1, 13 had antibodies only against HLA-C, -DP, -DQ, or -DRB3/4/5, and 17 had antibodies both against HLA-C, -DP, -DQ, or -DRB3/4/5 and against HLA-A, -B, or -DRB1. Because CB units had not been typed at HLA-C, -DP, -DQ, or -DRB3/4/5, it was possible that antibodies against them were unrecognized donor-specific antibodies. Patients with antibodies only against HLA-A, -B, or -DRB1 showed comparable neutrophil engraftment rates to those without antibodies (89.7% versus 83%, P = .65), whereas patients having antibodies against C, DP, DQ, or -DRB3/4/5 showed lower engraftment rate (66.7%, P = .12), which became statistically significant in a subgroup of HLA-mismatched donor-recipient pairs (50%, P = .01). Our results demonstrated that the presence of donor nonspecific anti-HLA-A, -B, -DRB1 antibodies had no significant influence on engraftment, whereas anti-HLA-C, -DP, -DQ, or -DRB3/4/5 antibodies adversely affect engraftment, possibly because of unrecognized donor-specific anti-HLA antibodies against them, especially in HLA-mismatched CBT.
除供者特异性抗HLA - A、- B、- DRB1抗体外，抗HLA抗体对移植物植入的影响在175例单份脐血移植（CBT）中进行了回顾性评估。患者和供者均进行了HLA - A、- B和 - DRB1抗原分型，并且在移植前筛查了抗HLA抗体，以避免使用带有相应抗原的脐血（CB）单位。中位年龄为59岁（范围17至74岁）。总体而言，61%为男性，89%处于高危疾病状态，77%接受了清髓性预处理方案，超过80%为多次输血患者。175例中有69例（39.4%）抗HLA抗体呈阳性。39例患者仅具有针对HLA - A、- B或 - DRB1的抗体，13例仅具有针对HLA - C、- DP、- DQ或 - DRB3/4/5的抗体，17例同时具有针对HLA - C、- DP、- DQ或 - DRB3/4/5以及针对HLA - A、- B或 - DRB1的抗体。由于CB单位未进行HLA - C、- DP、- DQ或 - DRB3/4/5分型，针对这些抗原的抗体有可能是未被识别的供者特异性抗体。仅具有针对HLA - A、- B或 - DRB1抗体的患者中性粒细胞植入率与无抗体患者相当（89.7%对83%，P = 0.65），而具有针对C、DP、DQ或 - DRB3/4/5抗体的患者植入率较低（66.7%，P = 0.12），在HLA错配供受者对的亚组中具有统计学意义（50%，P = 0.01）。我们的结果表明，供者非特异性抗HLA - A、- B、- DRB1抗体的存在对植入没有显著影响，而抗HLA - C、- DP、- DQ或 - DRB3/4/5抗体对植入有不利影响，可能是因为存在未被识别的针对这些抗原的供者特异性抗HLA抗体，尤其是在HLA错配的CBT中。
