Prospective monitoring for alloimmunization in cord blood transplantation: "virtual crossmatch" can be used to demonstrate donor-directed antibodies.
Preformed host antibodies may contribute to graft rejection after hematopoietic stem-cell transplantation. In cord blood transplantation (CBT), donor-directed host antibodies may be particularly relevant because patients are often markedly mismatched to donors, and limited donor cells preclude cross-matching. The recent development of single human leukocyte antigen (HLA) microbead array assays allows characterization of host alloreactivity to individual HLA antigens with sufficient sensitivity and specificity to allow consideration of "virtual crossmatch" testing as a surrogate for conventional crossmatch testing in the CBT setting. We report results of prospective monitoring for alloimmunization in our recent CBT experience. Among 46 consecutive patients, four patients (9%) (5 of 88 units [6%]) had evidence of at least moderate antibodies to HLA antigens on cord units originally selected for transplantation. Virtual crossmatch can be used to screen for donor-directed antibodies in CBT. As possible, units should be changed to avoid sensitized mismatches.
Gutman
Jonathan A
JA
Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA. jgutman@fhcrc.org
McKinney
Susan K
SK
Pereira
Shalini
S
Warnock
Sandra L
SL
Smith
Anajane G
AG
Woolfrey
Ann E
AE
Hansen
John A
JA
Delaney
Colleen
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods*; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D007518:Isoantibodies / Q000097:blood*; D007938:Leukemia / Q000601:surgery; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009182:Mycosis Fungoides / Q000601:surgery; D009190:Myelodysplastic Syndromes / Q000601:surgery; D012680:Sensitivity and Specificity; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
D006680:HLA Antigens; D007518:Isoantibodies