Positive serum crossmatch as predictor for graft failure in HLA-mismatched allogeneic blood stem cell transplantation.
BACKGROUND
Evaluation of patient sera for complement-fixing anti-donor antibodies (serum crossmatch [XM]) before allogeneic blood stem cell transplantation (BSCT) is routine in most centers. However, in contrast to kidney transplantation, the predictive value of a positive XM for outcome of BSCT is still unclear, and a positive XM is presently not regarded as an absolute contraindication to proceed to transplant.


METHODS
To clarify the role of a positive XM as predictor for overall survival (OS) and graft failure (GF) after BSCT, a retrospective, single-center, matched-pair analysis was performed. Enrolled were all XM-positive BSCT performed at our institution from 1985 to 2000 (n=30). Controls (n=30) were matched for disease, disease stage, patient age, period of transplant, conditioning regimen, protocol for prevention of graft-versus-host disease, and type of donor (related vs. unrelated, HLA-identical vs. HLA-mismatched).


RESULTS
Multivariate statistical analysis of all enrolled 60 transplants revealed GF as the all-dominating, independent risk factors for low OS (relative risk [RR]: 59.5, P<0.0001). Univariate (Kaplan-Meier) analysis could attribute inferior OS and high incidence of GF to the subgroup of HLA-mismatched, XM-positive transplants (P=0.01).


CONCLUSIONS
A XM should always be performed in patients awaiting a BSCT from HLA-mismatched donors, because a positive XM is a predictor for inferior OS due to GF in BSCT.
Ottinger
Hellmut D
HD
Institute of Immunology, Departments of Bone Marrow Transplantation, and Paediatric Haematology, Oncology and Endocrinology, University Hospital of Essen, 45122 Essen, Germany.
Rebmann
Vera
V
Pfeiffer
Kerstin A
KA
Beelen
Dietrich W
DW
Kremens
Bernhard
B
Runde
Volker
V
Schaefer
Ulrich W
UW
Grosse-Wilde
Hans
H
D000293:Adolescent; D000328:Adult; D001787:Blood Group Incompatibility; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival / Q000276:immunology*; D006680:HLA Antigens / Q000276:immunology*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods / Q000401:mortality; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D016130:Immunophenotyping; D007959:Lymphocyte Culture Test, Mixed; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015996:Survival Rate; D017211:Treatment Failure
D006680:HLA Antigens