Basturk Bilkay, Kasar Mutlu, Yeral Mahmut, Kavuzlu Miray
Department of Immunology, Baskent University, Ankara, Turkey; Department of Hematology and; Immunology Tissue Typing Laboratory, Baskent University, Adana, Turkey.
Exp Clin Transplant. 2017 Feb;15(Suppl 1):219-223. doi: 10.6002/ect.mesot2016.P99.
Allogeneic hematopoietic stem cell transplant provides a curative treatment for a considerable amount of hematologic diseases, and it is widely used today. Successful allogeneic stem cell transplant can be compromised by treatment-related toxicity, graft-versus-host disease, infectious complications, disease relapse, and graft failure. Primary graft failure is an important cause of hematopoietic stem cell transplant failure. Primary graft failure correlates with the level of complement-binding, donor-specific anti-HLA antibodies prior to transplant.
We evaluated 15 patients who underwent hematopoietic stem cell transplant using peripheral blood stem cells in terms of graft failure and anti-HLA antibody levels before transplant. All were treated between January 2015 and June 2016. Pretreatment serum anti-HLA class I and anti-HLA class II antibody levels were measured in all patients.
Anti-HLA class I antibodies were present in 7 patients (46.6%) and anti-HLA class II antibodies in 8 (53.3%). All three patients who developed primary graft failure were anti-HLA-positive.
Anti-HLA antibodies are a significant cause of graft failure. It is a situation that must be understood with caution. Our results support the considerations that allogeneic hematopoietic stem cell transplant, especially when a fully compatible sibling donor is not present, should include screening of donor-specific antibodies of alternative donors and desensitization therapy for allosensitized patients before transplant.
异基因造血干细胞移植为大量血液系统疾病提供了一种治愈性治疗方法，目前被广泛应用。成功的异基因干细胞移植可能会受到治疗相关毒性、移植物抗宿主病、感染并发症、疾病复发和移植物失败的影响。原发性移植物失败是造血干细胞移植失败的一个重要原因。原发性移植物失败与移植前补体结合、供体特异性抗HLA抗体水平相关。
我们评估了15例接受外周血干细胞造血干细胞移植的患者的移植物失败情况以及移植前的抗HLA抗体水平。所有患者均在2015年1月至2016年6月期间接受治疗。对所有患者进行了预处理血清抗HLA I类和抗HLA II类抗体水平检测。
7例患者（46.6%）存在抗HLA I类抗体，8例患者（53.3%）存在抗HLA II类抗体。发生原发性移植物失败的3例患者均为抗HLA阳性。
抗HLA抗体是移植物失败的一个重要原因。这是一种必须谨慎理解的情况。我们的结果支持以下考虑，即异基因造血干细胞移植，尤其是在没有完全匹配的同胞供体时，应包括对替代供体的供体特异性抗体进行筛查，并在移植前对致敏患者进行脱敏治疗。
