Impact of anti-HLA antibodies on allogeneic hematopoietic stem cell transplantation outcomes after reduced-intensity conditioning regimens.
Anti-human leukocyte antigen (HLA) antibodies are associated with several complications in solid organ transplantations, but their impact after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is not yet well defined. To evaluate the relevance of anti-HLA antibodies, we have retrospectively analyzed 107 peripheral blood allo-HSCTs after reduced-intensity conditioning regimen between 2005 and 2010. Acute myeloid leukemia and multiple myeloma were the most frequent malignancies in the cohort. The detection of anti-HLA antibodies was systematically performed in all patients before transplantation. Anti-HLA antibodies were present in 24 patients (22%). There was no significant impact of anti-HLA antibodies on engraftment, incidence of relapse, and incidence of acute graft-vs-host disease. The presence of anti-HLA antibodies was associated with significantly worse overall survival (p = 0.006) and event-free survival (p = 0.024) after stratification on sex. The 3-year probability of overall survival was 34% without anti-HLA antibodies and 16% in their presence. Patients with anti-HLA antibodies had a higher transplant-related mortality associated with life-threatening vascular complications. Our study supports that anti-HLA antibodies should be tested and considered as an important impacting factor for transplantation outcomes after reduced-intensity conditioning allo-HSCT. We recommend its consideration before allo-HSCT in the donor-recipient selection parameters.
Blood and Marrow Transplant Unit, Department of Hematology, Centre Hospitalier Lyon Sud, University of Lyon, Lyon, France.
Marie
M
Detrait
Valérie
V
Dubois
Mohamad
M
Sobh
Stéphane
S
Morisset
Nathalie
N
Tedone
Hélène
H
Labussière
Lilia
L
Gillis
Fiorenza
F
Barraco
Giovanna
G
Cannas
Sophie
S
Ducastelle
Jihane
J
Fatoum
Xavier
X
Thomas
Youcef
Y
Chelgoum
Franck-Emmanuel
FE
Nicolini
Mauricette
M
Michallet
D000208:Acute Disease; D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood*; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000097:blood / Q000401:mortality / Q000628:therapy; D006680:HLA Antigens; D019337:Hematologic Neoplasms / Q000097:blood / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
D001323:Autoantibodies; D006680:HLA Antigens