title: Human leucocyte antigen alloimmunization after bone marrow transplantation: an association with chronic myelogenous leukaemia.
abstract: Platelet refractoriness due to human leucocyte antigen (HLA) alloimmunization is a significant risk to allogeneic bone marrow transplant recipients. To identify factors contributing to this risk, we reviewed the records of 317 consecutive, paediatric, allogeneic bone marrow transplant recipients at a single institution. The 6-year estimated cumulative incidence of platelet refractoriness due to HLA alloimmunization was 2.6% +/- 0.9%. The incidence among patients with chronic myelogenous leukaemia (CML) 12.5% +/- 5.3% was significantly greater than that of other patients (1.1% +/- 0.6%, P < 0.001). Graft rejection (P = 0.003) and the number of platelet transfusions during the first 90 d after bone marrow transplantation (BMT) (P = 0.0025) were also significantly associated with alloimmunization. The association with CML and with graft rejection was not seen among patients alloimmunized before transplantation. Eight patients developed alloimmunization, of whom three had mismatched grafts and four had unrelated grafts. Alloantibody specificities, identified in seven patients, were unrelated to host or graft major histocompatibility complex (MHC). Host recognition of alloantigens in transfused blood products, not graft-host recognition, therefore seems predominantly responsible for the alloimmunization. These results show that paediatric CML patients have a significantly increased risk of platelet refractoriness due to HLA alloimmunization after BMT. Identifying the mechanism for the increased alloimmunization risk may assist in the development of therapies to prevent platelet refractoriness.
authors.affiliation: Department of Pathology, Mail Stop 341, St. Jude Children's Research Hospital, 132 North Lauderdale Street, Memphis, TN 38105-2794, USA. terrence.geiger@stjude.org
authors.forename: Terrence L
authors.initials: TL
authors.lastname: Geiger
authors.forename: Paul
authors.initials: P
authors.lastname: Woodard
authors.forename: Xin
authors.initials: X
authors.lastname: Tong
authors.forename: Deo Kumar
authors.initials: DK
authors.lastname: Srivastava
authors.forename: Robyn
authors.initials: R
authors.lastname: Johnson
authors.forename: Victoria
authors.initials: V
authors.lastname: Turner
authors.forename: Gregory
authors.initials: G
authors.lastname: Hale
authors.forename: Stacye
authors.initials: S
authors.lastname: Richardson
mesh_terms: D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D017707:Erythrocyte Transfusion; D006084:Graft Rejection; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007518:Isoantibodies / Q000097:blood*; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000276:immunology*; D017713:Platelet Transfusion; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies