Thursday, December 20, 2012

Impact of donor specific anti-HLA antibodies on graft failure and survival after reduced intensity conditioning-unrelated cord blood transplantation. A Eurocord, Societe Francophone d'Histocompatibilite et d'Immunogenetique (SFHI) and Societe Francaise de Greffe de Moelle et de Therapie Cellulaire (SFGM-TC) analysis.

Background. Graft failure is a major complication after unrelated cord blood transplantation. Presence of HLA-antibodies before cord blood transplantation may impact graft failure. Design and Methods. 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 LuminexTM platform. Results were interpreted as mean fluorescence intensity (MFI) against donor-specific mismatch. Results. 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%. It was 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). Conclusions. 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 a HLA mismatched cord blood unit. Whenever possible it is important to avoid selecting a unit when the patient has donor-specific-anti-HLA-antibodies against (read more) Print this post

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