title: Impact of donor-specific anti-HLA antibodies on graft failure and survival after reduced intensity conditioning-unrelated cord blood transplantation: a Eurocord, Société Francophone d'Histocompatibilité et d'Immunogénétique (SFHI) and Société Française de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC) analysis.
abstract: Graft failure is a major complication after unrelated cord blood transplantation. Presence of HLA-antibodies before cord blood transplantation may impact graft failure. To analyze the effect of anti-HLA antibodies on unrelated cord blood transplantation outcomes, we analyzed 294 unrelated cord blood transplant recipients after reduced intensity conditioning regimen. The majority of the patients (82%) were transplanted for malignancies, 60% with double-unrelated cord blood transplant, 63% were HLA mismatched. Retrospectively, pre-unrelated cord blood transplant serum was tested for HLA-Ab using Luminex™ platform. Results were interpreted as mean fluorescence intensity (MFI) against donor-specific mismatch. Among 62 recipients (23%) who had anti-HLA antibodies before unrelated cord blood transplant, 14 patients had donor specific anti-HLA antibodies (DSA) (7 were donor-specific anti-HLA antibodies for single unrelated cord blood transplant and 7 for double unrelated cord blood transplant). Donor specific anti-HLA antibodies threshold ranged from 1620-17629 of mean fluorescence intensity (MFI). Cumulative incidence of Day-60 neutrophil engraftment was 76%: 44% for recipients with donor specific anti-HLA antibodies and 81% in those without donor specific anti-HLA antibodies (P=0.006). The cumulative incidence of 1-year transplant related mortality was 46% in patients with donor specific anti-HLA antibodies and 32% in those without antibodies (P=0.06). The presence of donor specific anti-HLA antibodies was associated with a trend for decreased survival rate (42% vs. 29%; P=0.07). Donor specific anti-HLA antibody in recipients of unrelated cord blood transplant is associated with graft failure and decreased survival. Patient's screening for donor specific anti-HLA antibodies before unrelated cord blood transplantation is recommended before choosing an HLA mismatched cord blood unit. Whenever possible it is important to avoid selecting a unit for which the patient has donor specific anti-HLA antibodies.
authors.affiliation: Eurocord, Hôpital Saint Louis APHP, University Paris VII IUH Paris, France.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Ruggeri
authors.forename: Vanderson
authors.initials: V
authors.lastname: Rocha
authors.forename: Emeline
authors.initials: E
authors.lastname: Masson
authors.forename: Myriam
authors.initials: M
authors.lastname: Labopin
authors.forename: Renato
authors.initials: R
authors.lastname: Cunha
authors.forename: Lena
authors.initials: L
authors.lastname: Absi
authors.forename: Ali
authors.initials: A
authors.lastname: Boudifa
authors.forename: Brigitte
authors.initials: B
authors.lastname: Coeffic
authors.forename: Anne
authors.initials: A
authors.lastname: Devys
authors.forename: Muriel
authors.initials: M
authors.lastname: De Matteis
authors.forename: Valérie
authors.initials: V
authors.lastname: Dubois
authors.forename: Daniel
authors.initials: D
authors.lastname: Hanau
authors.forename: Françoise
authors.initials: F
authors.lastname: Hau
authors.forename: Isabelle
authors.initials: I
authors.lastname: Jollet
authors.forename: Dominique
authors.initials: D
authors.lastname: Masson
authors.forename: Beatrice
authors.initials: B
authors.lastname: Pedron
authors.forename: Pascale
authors.initials: P
authors.lastname: Perrier
authors.forename: Christophe
authors.initials: C
authors.lastname: Picard
authors.forename: Annie
authors.initials: A
authors.lastname: Ramouneau-Pigot
authors.forename: Fernanda
authors.initials: F
authors.lastname: Volt
authors.forename: Dominique
authors.initials: D
authors.lastname: Charron
authors.forename: Eliane
authors.initials: E
authors.lastname: Gluckman
authors.forename: Pascale
authors.initials: P
authors.lastname: Loiseau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000096:biosynthesis / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005312:Fetal Blood / Q000166:cytology / Q000276:immunology; D005500:Follow-Up Studies; D005602:France; D006085:Graft Survival / Q000276:immunology*; D006680:HLA Antigens / Q000097:blood* / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality / Q000639:trends*; D006648:Histocompatibility / Q000235:genetics / Q000276:immunology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012955:Societies, Medical / Q000639:trends; D015996:Survival Rate / Q000639:trends; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000401:mortality / Q000639:trends*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D006680:HLA Antigens