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Allografting

Risk and prevention of graft failure in patients with preexisting donor-specific HLA antibodies undergoing unmanipulated haploidentical SCT

Bone Marrow Transplantation volume 47, pages 508–515 (2012)Cite this article

Abstract

A role of donor-specific HLA antibodies (DSA) in graft failure after SCT has been suggested, but the relevance of DSA in unmanipulated haploidentical SCT (haplo-SCT) remains unknown. We prospectively examined HLA antibodies using the Luminex-based single Ag assay for 79 adult patients undergoing unmanipulated haplo-SCT. Among them, 16 (20.2%) were HLA Ab-positive, including five patients with antibodies not corresponding to donor HLA Ags and 11 DSA-positive patients. Of the 11 DSA-positive patients, five received treatments to decrease DSA levels, including two, who received plasma exchange and rituximab, two who received platelet transfusions from healthy-related donors having DSA-corresponding HLA Ags and one who received bortezomib. Platelet transfusion was the most simple and effective treatment option for class I DSA. The cumulative incidence of neutrophil recovery was significantly lower in pretransplant (post-treatment) DSA-positive patients than in DSA-negative patients (61.9 vs 94.4%, P=0.026). Notably, three of five patients with high levels of DSA had graft failure. Donors should be selected on the basis of an evaluation of HLA antibodies. If haplo-SCT from donors with HLA Ags that correspond to high levels of DSA must be performed, then recipients should be treated for DSA to improve the chances of successful donor engraftment.

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Acknowledgements

We thank the medical, nursing and laboratory staff for their contributions to this study. We are also grateful to Ms Aki Yano and Ms Kimiko Yamamoto for their excellent technical assistance and to Ms Saori Hatemura, Mr Shigeo Kimura, Ms Kazuko Saida and Ms Kumiko Sugawara for their assistance with data collection.

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Authors and Affiliations

  1. Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan

    S Yoshihara, K Taniguchi, K Kaida, R Kato, T Inoue, T Fujioka, K Ikegame, M Okada, T Soma & H Ogawa

  2. HLA Laboratory, Kyoto, Japan

    E Maruya, K Hayashi, N Fujii, T Onuma, Y Kusunoki & H Saji

  3. Laboratory of Cell Transplantation, Institute for Advanced Medical Sciences, Hyogo College of Medicine, Hyogo, Japan

    H Tamaki

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  1. S Yoshihara
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Correspondence to S Yoshihara.

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Yoshihara, S., Maruya, E., Taniguchi, K. et al. Risk and prevention of graft failure in patients with preexisting donor-specific HLA antibodies undergoing unmanipulated haploidentical SCT. Bone Marrow Transplant 47, 508–515 (2012). https://doi.org/10.1038/bmt.2011.131

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  • DOI: https://doi.org/10.1038/bmt.2011.131

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