title: Risk and prevention of graft failure in patients with preexisting donor-specific HLA antibodies undergoing unmanipulated haploidentical SCT.
abstract: A role of donor-specific HLA antibodies (DSA) in graft failure after SCT has been suggested, but the relevance of DSA in unmanipulated haploidentical SCT (haplo-SCT) remains unknown. We prospectively examined HLA antibodies using the Luminex-based single Ag assay for 79 adult patients undergoing unmanipulated haplo-SCT. Among them, 16 (20.2%) were HLA Ab-positive, including five patients with antibodies not corresponding to donor HLA Ags and 11 DSA-positive patients. Of the 11 DSA-positive patients, five received treatments to decrease DSA levels, including two, who received plasma exchange and rituximab, two who received platelet transfusions from healthy-related donors having DSA-corresponding HLA Ags and one who received bortezomib. Platelet transfusion was the most simple and effective treatment option for class I DSA. The cumulative incidence of neutrophil recovery was significantly lower in pretransplant (post-treatment) DSA-positive patients than in DSA-negative patients (61.9 vs 94.4%, P=0.026). Notably, three of five patients with high levels of DSA had graft failure. Donors should be selected on the basis of an evaluation of HLA antibodies. If haplo-SCT from donors with HLA Ags that correspond to high levels of DSA must be performed, then recipients should be treated for DSA to improve the chances of successful donor engraftment.
authors.affiliation: Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan. yoshihar@hyo-med.ac.jp
authors.forename: S
authors.initials: S
authors.lastname: Yoshihara
authors.forename: E
authors.initials: E
authors.lastname: Maruya
authors.forename: K
authors.initials: K
authors.lastname: Taniguchi
authors.forename: K
authors.initials: K
authors.lastname: Kaida
authors.forename: R
authors.initials: R
authors.lastname: Kato
authors.forename: T
authors.initials: T
authors.lastname: Inoue
authors.forename: T
authors.initials: T
authors.lastname: Fujioka
authors.forename: H
authors.initials: H
authors.lastname: Tamaki
authors.forename: K
authors.initials: K
authors.lastname: Ikegame
authors.forename: M
authors.initials: M
authors.lastname: Okada
authors.forename: T
authors.initials: T
authors.lastname: Soma
authors.forename: K
authors.initials: K
authors.lastname: Hayashi
authors.forename: N
authors.initials: N
authors.lastname: Fujii
authors.forename: T
authors.initials: T
authors.lastname: Onuma
authors.forename: Y
authors.initials: Y
authors.lastname: Kusunoki
authors.forename: H
authors.initials: H
authors.lastname: Saji
authors.forename: H
authors.initials: H
authors.lastname: Ogawa
mesh_terms: D000293:Adolescent; D000328:Adult; D046148:Donor Selection / Q000379:methods; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000276:immunology / Q000517:prevention & control; D006680:HLA Antigens; D019337:Hematologic Neoplasms / Q000097:blood / Q000276:immunology / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007518:Isoantibodies / Q000097:blood* / Q000276:immunology; D008297:Male; D012307:Risk Factors; D014019:Tissue Donors; D014184:Transplantation, Homologous
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies