title: Pre-existing anti-HLA antibodies negatively impact survival of pediatric aplastic anemia patients undergoing HSCT.
abstract: Graft failure and survival are the major problems for patients with aplastic anemia undergoing hematopoietic stem cell transplantation (HSCT). Previous studies showed that anti-HLA antibodies negatively impact engraftment in HSCT. This retrospective study of 51 pediatric patients with acquired aplastic anemia who underwent allogeneic HSCT at a single institution between 2006 and 2012 investigated the influence of anti-HLA antibodies on the outcome of HSCT. Serum samples collected before HSCT were tested for the presence of anti-HLA antibodies. Pre-existing anti-HLA antibodies were detected in 54.9% (28/51) of patients, among whom 39.2% (20/51) had anti-HLA class I antibodies. Anti-HLA antibodies were associated with worse five-yr survival (78.6% vs. 100%, p = 0.021) and higher treatment-related mortality (21.4% vs. 0%, p = 0.028) compared with antibody-negative patients. Anti-HLA class I antibody-positive patients had poorer five-yr survival (75.0%) than anti-HLA class I&II antibody-positive and antibody-negative patients (87.5% and 100.0%, respectively, p = 0.039). Presence of anti-HLA class I antibodies (p = 0.024) and older age (10 yr or more; p = 0.027) significantly increased the risk of post-HSCT mortality. Pre-existing anti-HLA antibodies negatively affect the outcome of HSCT in pediatric patients with aplastic anemia. Routine testing for anti-HLA antibodies concurrent with efficient treatment should be conducted prior to HSCT.
authors.affiliation: Key Laboratory of Pediatric Hematology & Oncology Ministry of Health, Department of Pediatric Hematology/Oncology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Zhu
authors.forename: Jun
authors.initials: J
authors.lastname: He
authors.forename: Junchao
authors.initials: J
authors.lastname: Cai
authors.forename: Xiaoni
authors.initials: X
authors.lastname: Yuan
authors.forename: Hua
authors.initials: H
authors.lastname: Jiang
authors.forename: Changying
authors.initials: C
authors.lastname: Luo
authors.forename: Jianmin
authors.initials: J
authors.lastname: Wang
authors.forename: Chengjuan
authors.initials: C
authors.lastname: Luo
authors.forename: Zhijuan
authors.initials: Z
authors.lastname: Pan
authors.forename: Paul I
authors.initials: PI
authors.lastname: Terasaki
authors.forename: Lixia
authors.initials: L
authors.lastname: Ding
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000741:Anemia, Aplastic / Q000097:blood* / Q000401:mortality / Q000628:therapy*; D000906:Antibodies / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006680:HLA Antigens / Q000276:immunology*; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000906:Antibodies; D006680:HLA Antigens
keywords: anti-HLA antibodies; hematopoietic stem cell transplantation; outcome; pediatric aplastic anemia