Peking University People's Hospital and Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No. 11 South Street of Xizhimen, Xicheng District, Beijing, 100044, P. R. China.
Peking-Tsinghua Center for Life Sciences, Beijing, 100871, China.
Bone Marrow Transplant. 2019 Aug;54(8):1287-1294. doi: 10.1038/s41409-018-0427-7. Epub 2019 Jan 17.
Donor-specific anti-human leukocyte antigen (HLA) antibodies (DSAs) were associated with graft failure (GF) following haploidentical stem cell transplantation (Haplo-HSCT). The prevalence and risk factors of DSAs in pediatric candidates remain to be determined. In a prospective trial (ChiCTR-OPC-15006672), 486 children with hematological diseases were enrolled to screen for the presence of anti-HLA class I and II antibodies of immunoglobulin G type. Fifty two patients (10.7%) demonstrated positive panel-reactive antibody (PRA) for class I; 24 (4.9%), for class II; and 13 (2.7%), for both. Multivariate analysis showed diagnosis was the independent risk factor for antibodies, as acute lymphoblastic leukemia (ALL) patients (HR0.141, 95% CI: 0.037-0.538, p = 0.004) had a lower incidence of class II PRAs and DSAs against HLA-B, DQ, and DR, whereas myelodysplastic syndrome (MDS) patients had a higher incidence of PRAs for both class I and class II (HR4.790, 95% CI: 1.010-22.716, p = 0.049), and DSAs against HLA-A, B, C, DP, and DQ. Older age (>12 vs. ≤12) was associated with DSAs against HLA-DP (HR0.194, 95% CI: 0.041-0.918, p = 0.039). Our findings provided novel evidence for prevalence and risk factors for PRAs and DSAs in pediatric candidates receiving haplo-HSCT, possibly benefiting anti-HLA antibody monitoring and donor selection.
供者特异性抗人类白细胞抗原（HLA）抗体（DSA）与单倍体造血干细胞移植（haplo-HSCT）后移植物失败（GF）有关。儿科患者中 DSA 的患病率和危险因素仍有待确定。在一项前瞻性试验（ChiCTR-OPC-15006672）中，纳入了 486 名患有血液系统疾病的儿童，以筛查免疫球蛋白 G 型抗 HLA Ⅰ类和Ⅱ类抗体的存在情况。52 名患者（10.7%）表现出Ⅰ类的阳性面板反应性抗体（PRA）；24 名（4.9%）为Ⅱ类；13 名（2.7%）为两类。多变量分析显示，诊断是抗体的独立危险因素，急性淋巴细胞白血病（ALL）患者（HR0.141，95%CI：0.037-0.538，p=0.004）发生Ⅱ类 PRA 和针对 HLA-B、DQ 和 DR 的 DSA 的发生率较低，而骨髓增生异常综合征（MDS）患者的Ⅰ类和Ⅱ类 PRA 的发生率均较高（HR4.790，95%CI：1.010-22.716，p=0.049），以及针对 HLA-A、B、C、DP 和 DQ 的 DSA。年龄较大（>12 岁与≤12 岁）与针对 HLA-DP 的 DSA 相关（HR0.194，95%CI：0.041-0.918，p=0.039）。我们的研究结果为接受 haplo-HSCT 的儿科患者中 PRA 和 DSA 的患病率和危险因素提供了新的证据，可能有利于抗 HLA 抗体监测和供者选择。
