Servizio di Immunoematologia e Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
Hematology Department, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
Curr Res Transl Med. 2024 Sep;72(3):103464. doi: 10.1016/j.retram.2024.103464. Epub 2024 Aug 17.
While the detrimental role of donor-specific anti-HLA antibodies (DSAs) is well-described in the setting of hematopoietic stem cell transplantation (HSCT), few studies focus on non donor-specific ones and with controversial results.
We here report our monocenter experience on 64 adult patients receiving allogeneic HSCT from a HLA-mismatched donor between 2014 and 2022 who were tested for the presence of anti-HLA antibodies before transplant, focusing on fifteen patients with non donor-specific anti-HLA antibodies.
The survival of patients with non donor-specific anti-HLA antibodies was inferior with respect to patients without anti-HLA antibodies and similar to patients with DSAs. Median survival of patients with non donor-specific anti-HLA antibodies was 21 months (95 % CI: 9-42) vs. 61 months (95 % CI: 17-77) among the anti-HLA antibody-negative patients, with a significantly higher mortality incidence rate ratio (3.3 times-fold greater, p = 0.01). No pattern of death causes was found CONCLUSIONS: In this monocenter series of HLA-mismatched HSCTs, impaired survival was observed in adult patients having non donor-specific anti-HLA antibodies before transplant, similar to those with DSAs. Our findings support those antibodies as a negative predictive factor even if they are not directed against the donor, thus warranting further investigation on larger cohorts.
虽然供体特异性抗 HLA 抗体（DSA）在造血干细胞移植（HSCT）中具有明确的有害作用，但很少有研究关注非供体特异性抗体，且结果存在争议。
我们在此报告了我们单中心在 2014 年至 2022 年间对 64 名接受 HLA 错配供体异基因 HSCT 的成年患者的经验，这些患者在移植前均进行了抗 HLA 抗体检测，重点关注了 15 名具有非供体特异性抗 HLA 抗体的患者。
与无抗 HLA 抗体的患者相比，具有非供体特异性抗 HLA 抗体的患者的生存情况较差，与具有 DSA 的患者相似。具有非供体特异性抗 HLA 抗体的患者的中位生存时间为 21 个月（95%CI：9-42），而无抗 HLA 抗体的患者为 61 个月（95%CI：17-77），死亡率的发生率比值更高（高 3.3 倍，p=0.01）。未发现死亡原因的模式。
在这项 HLA 错配 HSCT 的单中心系列研究中，移植前具有非供体特异性抗 HLA 抗体的成年患者的生存受到影响，与具有 DSA 的患者相似。我们的发现支持这些抗体作为阴性预测因素，即使它们不是针对供体的，因此需要在更大的队列中进一步研究。
