title: The impact of anti-HLA antibodies on unrelated cord blood transplantations.
abstract: The majority of cord blood transplantations (CBTs) have human leukocyte antigen (HLA) disparities. We investigated the impact that patients' pretransplantation anti-HLA antibodies have on the outcome of CBTs. Testing for anti-HLA antibody and its specificity was performed retrospectively at the Japanese Red Cross Tokyo Blood Center with sensitive solid-phase antibody detection assays. Among 386 CBTs, which were first myeloablative stem cell transplantations for malignancies and used a single unit of cord blood, 89 tested positive. Among the antibody-positive group, the cord blood did not have the corresponding HLA type for the antibody in 69 cases (ab-positive), while 20 cases had specificity against the cord blood HLA (positive-vs-CB). Cumulative incidence of neutrophil recovery 60 days after transplantation was 83% (95% confidence interval [CI], 79%-87%) for the antibody-negative group (ab-negative), 73% (95% CI, 61%-82%) for ab-positive, but only 32% (95% CI, 13%-53%) for the positive-vs-CB (P < .0001, Gray test). With multivariate analysis, the ab-positive showed significantly lower neutrophil recovery than the ab-negative (relative risk [RR] = 0.69, 95% CI, 0.49-0.96, p = .027). The positive-vs-CB had significantly lower neutrophil recovery (RR = 0.23, 95% CI, 0.09-0.56, P = .001) and platelet recovery (RR = 0.31, 95% CI, 0.12-0.81, P = .017) than the ab-negative. Patients' pretransplantation anti-HLA antibodies should be tested and considered in the selection of cord blood.
authors.affiliation: Japanese Red Cross Tokyo Blood Center, Tokyo, Japan. mi-takanashi@tokyo.bc.jrc.or.jp
authors.forename: Minoko
authors.initials: M
authors.lastname: Takanashi
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Atsuta
authors.forename: Koki
authors.initials: K
authors.lastname: Fujiwara
authors.forename: Hideki
authors.initials: H
authors.lastname: Kodo
authors.forename: Shunro
authors.initials: S
authors.lastname: Kai
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sato
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kohsaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Azuma
authors.forename: Hidenori
authors.initials: H
authors.lastname: Tanaka
authors.forename: Atsuko
authors.initials: A
authors.lastname: Ogawa
authors.forename: Kazunori
authors.initials: K
authors.lastname: Nakajima
authors.forename: Shunichi
authors.initials: S
authors.lastname: Kato
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology*; D019337:Hematologic Neoplasms / Q000097:blood / Q000276:immunology* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007518:Isoantibodies / Q000097:blood*; D007564:Japan / Q000453:epidemiology; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009504:Neutrophils; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018952:Antigens, CD34; D006680:HLA Antigens; D007518:Isoantibodies