Hagino Takeshi, Ikegame Kazuhiro, Tanaka Hidenori, Kanda Yoshinobu, Kaida Katsuji, Fukuda Takahiro, Kondo Yukio, Sato Maho, Doki Noriko, Nakamae Hirohisa, Matsuoka Ken-Ichi, Mori Yasuo, Sano Hideki, Eto Tetsuya, Kawakita Toshiro, Hashii Yoshiko, Ichinohe Tatsuo, Atsuta Yoshiko, Kanda Junya
Department of Hematology, Tama-Hokubu Medical Center, Tokyo Metropolitan Health and Medical Treatment Corporation, Tokyo, Japan.
Hematopoietic Cell Transplantation Center, Aichi Medical University of School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
Int J Hematol. 2025 Jun;121(6):848-856. doi: 10.1007/s12185-025-03952-y. Epub 2025 Mar 20.
Anti-human leukocyte antigen (HLA) antibodies, particularly donor-specific HLA antibodies (DSA), negatively impact engraftment in hematopoietic cell transplantation. Past studies have proposed various interventions to reduce DSA, but these were primarily from single centers and not from large-scale registry data. Therefore, we conducted a retrospective analysis of nationwide registry data to examine the effects of anti-HLA antibodies on engraftment. Evaluable patients were classified into an anti-HLA antibody-negative group (n = 3657), an anti-HLA antibody-positive group (without high DSA) (n = 137), and a high-DSA (MFI > 5000) group (n = 8). Patient characteristics differed significantly between the anti-HLA antibody-negative and anti-HLA antibody-positive groups, and the number of patients with DSA was lower than expected. Statistical analyses revealed that the anti-HLA antibody-positive group had better neutrophil engraftment than the anti-HLA antibody-negative group (94.0% vs 84.2%, p < 0.001) but worse platelet engraftment (60.3% vs 64.9%, p = 0.047). In the high DSA group, two patients received a DSA-depleting intervention. Only one patient with an MFI of 5832 (without intervention) developed primary graft failure, while the remaining seven achieved engraftment. In this study, the effect of anti-HLA antibodies remained inconclusive, and the possibility of neutrophil engraftment with high-DSA levels was confirmed.
抗人类白细胞抗原（HLA）抗体，尤其是供体特异性HLA抗体（DSA），会对造血细胞移植中的植入产生负面影响。过去的研究提出了各种减少DSA的干预措施，但这些主要来自单一中心，而非大规模登记数据。因此，我们对全国登记数据进行了回顾性分析，以研究抗HLA抗体对植入的影响。可评估的患者被分为抗HLA抗体阴性组（n = 3657）、抗HLA抗体阳性组（无高DSA）（n = 137）和高DSA（平均荧光强度>MFI>5000）组（n = 8）。抗HLA抗体阴性组和抗HLA抗体阳性组之间的患者特征存在显著差异，且DSA患者数量低于预期。统计分析显示，抗HLA抗体阳性组的中性粒细胞植入情况优于抗HLA抗体阴性组（94.0%对84.2%，p<0.001），但血小板植入情况较差（60.3%对64.9%，p = 0.047）。在高DSA组中，两名患者接受了DSA清除干预。只有一名平均荧光强度为5832的患者（未干预）发生了原发性移植失败，其余七名患者实现了植入。在本研究中，抗HLA抗体的影响仍不明确，且证实了高DSA水平下中性粒细胞植入的可能性。
