title: Anti-HLA antibodies other than against HLA-A, -B, -DRB1 adversely affect engraftment and nonrelapse mortality in HLA-mismatched single cord blood transplantation: possible implications of unrecognized donor-specific antibodies.
abstract: The impact of anti-HLA antibodies, except for donor-specific anti-HLA-A, -B, -DRB1 antibodies, on engraftment was retrospectively evaluated in 175 single cord blood transplantations (CBT). Patients and donors had been typed at HLA-A, -B, and -DRB1 antigens, and anti-HLA antibodies had been screened before transplantation to avoid the use of cord blood (CB) units with corresponding antigens. The median age was 59 (range, 17 to 74) years. Overall, 61% were male, 89% had high-risk disease status, 77% received myeloablative conditioning regimens, and over 80% were heavily transfused patients. Sixty-nine of the 175 (39.4%) were positive for anti-HLA antibodies. Thirty-nine patients had antibodies only against HLA-A, -B, or -DRB1, 13 had antibodies only against HLA-C, -DP, -DQ, or -DRB3/4/5, and 17 had antibodies both against HLA-C, -DP, -DQ, or -DRB3/4/5 and against HLA-A, -B, or -DRB1. Because CB units had not been typed at HLA-C, -DP, -DQ, or -DRB3/4/5, it was possible that antibodies against them were unrecognized donor-specific antibodies. Patients with antibodies only against HLA-A, -B, or -DRB1 showed comparable neutrophil engraftment rates to those without antibodies (89.7% versus 83%, P = .65), whereas patients having antibodies against C, DP, DQ, or -DRB3/4/5 showed lower engraftment rate (66.7%, P = .12), which became statistically significant in a subgroup of HLA-mismatched donor-recipient pairs (50%, P = .01). Our results demonstrated that the presence of donor nonspecific anti-HLA-A, -B, -DRB1 antibodies had no significant influence on engraftment, whereas anti-HLA-C, -DP, -DQ, or -DRB3/4/5 antibodies adversely affect engraftment, possibly because of unrecognized donor-specific anti-HLA antibodies against them, especially in HLA-mismatched CBT.
authors: Department of Hematology, Toranomon Hospital, Tokyo, Japan.
authors: Hisashi
authors: H
authors: Yamamoto
authors: Department of Hematology, Toranomon Hospital, Tokyo, Japan; Okinaka Memorial Institute for Medical Research, Tokyo, Japan. Electronic address: nuchida@toranomon.gr.jp.
authors: Naoyuki
authors: N
authors: Uchida
authors: Department of Hematology, Toranomon Hospital, Tokyo, Japan.
authors: Naofumi
authors: N
authors: Matsuno
authors: Department of Hematology, Toranomon Hospital, Tokyo, Japan; Department of Transfusion Medicine, Toranomon Hospital, Tokyo, Japan.
authors: Hikari
authors: H
authors: Ota
authors: Department of Hematology, Toranomon Hospital, Tokyo, Japan.
authors: Kosei
authors: K
authors: Kageyama
authors: Department of Hematology, Toranomon Hospital, Tokyo, Japan.
authors: Sachie
authors: S
authors: Wada
authors: Department of Hematology, Toranomon Hospital, Tokyo, Japan.
authors: Daisuke
authors: D
authors: Kaji
authors: Department of Hematology, Toranomon Hospital, Tokyo, Japan.
authors: Aya
authors: A
authors: Nishida
authors: Department of Hematology, Toranomon Hospital, Tokyo, Japan.
authors: Kazuya
authors: K
authors: Ishiwata
authors: Department of Hematology, Toranomon Hospital, Tokyo, Japan.
authors: Shinsuke
authors: S
authors: Takagi
authors: Department of Hematology, Toranomon Hospital, Tokyo, Japan.
authors: Masanori
authors: M
authors: Tsuji
authors: Department of Hematology, Toranomon Hospital, Tokyo, Japan.
authors: Yuki
authors: Y
authors: Asano-Mori
authors: Department of Hematology, Toranomon Hospital, Tokyo, Japan.
authors: Go
authors: G
authors: Yamamoto
authors: Department of Hematology, Toranomon Hospital, Tokyo, Japan; Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
authors: Koji
authors: K
authors: Izutsu
authors: Department of Hematology, Toranomon Hospital, Tokyo, Japan.
authors: Kazuhiro
authors: K
authors: Masuoka
authors: Department of Hematology, Toranomon Hospital, Tokyo, Japan.
authors: Atsushi
authors: A
authors: Wake
authors: Department of Infectious Diseases, Toranomon Hospital, Tokyo, Japan.
authors: Akiko
authors: A
authors: Yoneyama
authors: Department of Transfusion Medicine, Toranomon Hospital, Tokyo, Japan.
authors: Shigeyoshi
authors: S
authors: Makino
authors: Department of Hematology, Toranomon Hospital, Tokyo, Japan; Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
authors: Shuichi
authors: S
authors: Taniguchi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000918:Antibody Specificity; D036101:Cord Blood Stem Cell Transplantation; D005260:Female; D006085:Graft Survival; D006680:HLA Antigens / Q000145:classification / Q000276:immunology*; D019337:Hematologic Neoplasms / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D006650:Histocompatibility Testing; D006801:Humans; D007518:Isoantibodies / Q000096:biosynthesis* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies; D019653:Myeloablative Agonists
keywords: Anti-HLA antibodies; Cord blood transplantation; Nondonor specific