Dynamic Detection of Anti-Human Leukocyte Antigen (HLA) Antibodies but not HLA-DP Loci Mismatches Can Predict Acute Graft-versus-Host Disease and Overall Survival in HLA 12/12-Matched Unrelated Donor Allogeneic Hematopoietic Stem Cell Transplantation for Hematological Malignancies.
The National Marrow Donor Program and Center for International Blood and Marrow Transplant Research provided guidelines for the use of anti-HLA antibodies and HLA-DP-mismatched loci in unrelated donor hematopoietic stem cell transplantation (HSCT). However, a deeper understanding of other potentially useful biomarkers for predicting clinical outcomes in HLA-A, -B, -C, -DRB1, -DQB1, and -DQA1 (12/12)-matched unrelated donor HSCT is needed to further improve clinical outcomes. We tested HLA genotyping for 123 pairs of patients and donors. Anti-HLA antibodies using the Luminex method was applied to 123, 117, and 106 serum samples collected before and 1 month and 3 months after transplantation. The presences of anti-HLA antibodies at the 3 time points were 37.4% (46 of 123), 40.2% (47 of 117), and 22.6% (24 of 106). Mismatch of HLA-DPB1 and/or DPA1 allele between patient-donor pairs was 83.6% (92 of 110). Patients with anti-HLA antibodies had delayed platelet recovery. The presence of anti-HLA antibodies and their dynamic changes after transplantation were associated with increased occurrence of grades II to IV acute and chronic graft-versus-host disease (GVHD), higher treatment-related mortality, and reduced overall survival (OS) and disease-free survival, especially in acute myeloid leukemia and myelodysplastic syndrome patients. Multivariate analysis showed that presence of anti-HLA antibodies before transplantation was a risk factor for GVHD and OS. Furthermore, HLA-DP loci-matched subgroup showed a trend towards a lower rate of acute GVHD and a higher OS in the anti-HLA Abs-negative group. Our results suggest that dynamic changes of anti-HLA antibodies independently predict for a negative outcome of HSCT, independent of HLA-DP loci mismatches. Routine monitoring for anti-HLA antibody dynamics should be conducted before and after HSCT.
Department of HLA Laboratory, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.
Zhijuan
Z
Pan
Department of HLA Laboratory, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.
Xiaoni
X
Yuan
Department of HLA Laboratory, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.
Yang
Y
Li
Department of Hematology, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.
Xiaojin
X
Wu
Department of Hematology, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.
Wenjuan
W
Zhu
Department of HLA Laboratory, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.
Xiaojin
X
Bao
Department of Hematology, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.
Qinqin
Q
Zhao
Department of HLA Laboratory, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China. Electronic address: junhe1964@163.com.
Jun
J
He
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002648:Child; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006682:HLA-DP Antigens; D019337:Hematologic Neoplasms / Q000097:blood / Q000401:mortality / Q000628:therapy; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015996:Survival Rate; D061349:Unrelated Donors
D006682:HLA-DP Antigens; D007518:Isoantibodies
Acute graft-versus-host disease (aGVHD); Anti-HLA antibodies; HLA-DP; Hematopoietic stem cell transplantation (HSCT); Outcomes; Unrelated donor