title: Donor-Specific Anti-HLA Antibodies in Allogeneic Hematopoietic Stem Cell Transplantation.
abstract: Allogeneic hematopoietic stem cell transplantation (AHSCT) is a curative treatment for a wide variety of hematological diseases. In 30% of the cases, a geno-identical donor is available. Any other situation displays some level of human leukocyte antigen (HLA) incompatibility between donor and recipient. Deleterious effects of anti-HLA immunization have long been recognized in solid organ transplant recipients. More recently, anti-HLA immunization was shown to increase the risk of primary graft failure (PGF), a severe complication of AHSCT that occurs in 3-4% of matched unrelated donor transplantation and up to 15% in cord blood transplantation and T-cell depleted haplo-identical stem cell transplantation. Rates of PGF in patients with DSA were reported to be between 24 and 83% with the highest rates in haplo-identical and cord blood transplantation recipients. This led to the recommendation of anti-HLA antibody screening to detect donor-specific antibodies (DSA) in recipients prior to AHSCT. In this review, we highlight the role of anti-HLA antibodies in AHSCT and the mechanisms that may lead to PGF in patients with DSA, and discuss current issues in the field.
authors: Laboratoire d'Immunologie et Histocompatibilité, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP), Université Paris Diderot , Paris , France.
authors: Sarah
authors: S
authors: Morin-Zorman
authors: Laboratoire d'Immunologie et Histocompatibilité, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP), Université Paris Diderot , Paris , France.
authors: Pascale
authors: P
authors: Loiseau
authors: Laboratoire d'Immunologie et Histocompatibilité, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP), Université Paris Diderot , Paris , France.
authors: Jean-Luc
authors: JL
authors: Taupin
authors: Laboratoire d'Immunologie et Histocompatibilité, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP), Université Paris Diderot , Paris , France.
authors: Sophie
authors: S
authors: Caillat-Zucman
keywords: HLA antigens; allogeneic hematopoietic stem cell transplantation; donor-specific antibodies; graft failure; single antigen flow bead assay