Successful Engraftment in HLA-Mismatched Bone Marrow Transplantation Despite the Persistence of High-Level Donor-Specific Anti-HLA-DR Antibody

Graft failure remains the major complication after allogeneic stem cell transplantation. Presence of donor-specific anti–human leukocyte antigen (HLA) antibody (DSA) is not only a risk for graft failure mostly in cord blood transplantation (1), but also in other HLA mismatched related or unrelated stem cell transplantation. Here, we report successful engraftment after HLA mismatched unrelated bone marrow transplantation (BMT) in a patient with acute myeloid leukemia with myelodysplasia-related change, who had high-level anti-HLA-DR DSA... Intriguingly, in this case, severe skin and gut acute GVHD occurred on day +31 after transplantation, the period was just after the disappearance of DSA (Fig. 1). Previous reports suggested that incidence of acute GVHD was lower in patients with DSA compared with without DSA after cord blood transplantation. HLA-DR is usually expressed in activated T cells more than in resting T cells. It is therefore tempting to speculate that DSA may have a role in suppressing GVHD. Further investigation might be needed about the relationship between DSA, particularly against HLA-DR and GVHD (read more) Print this post