Donor-Specific Anti-Human Leukocyte Antigen Antibodies Predict Prolonged Isolated Thrombocytopenia and Inferior Outcomes of Haploidentical Hematopoietic Stem Cell Transplantation

Abstract

Prolonged isolated thrombocytopenia (PT) after allogeneic stem cell transplantation (allo-SCT) has a great impact on transplant outcome. In this study, we performed a retrospective analysis to investigate the association of donor-specific anti-human leukocyte antigen (HLA) antibodies (DSAs) with PT in 394 patients who underwent unmanipulated haploidentical blood and marrow transplantation (HBMT). For HLA antibody positive samples with a median fluorescent intensity (MFI) > 500, DSAs were further examined. A total of 390 patients (99.0%) achieved sustained myeloid engraftment. Of the 394 cases tested, 45 (11.4%) were DSA positive. The cumulative incidence of PT in this cohort of patients was 9.9 ± 1.5%. The incidence of PT was higher in patients with a MFI ≥ 1000 compared with those with a MFI < 1000 (16.8 ± 6.4% versus 7.4 ± 1.4%, P = 0.05). Multivariate analysis showed that the presence of DSAs (MFI ≥ 1000) was correlated to PT (hazard ratio (HR) 3.262; 95% confidence interval (CI), 1.339–7.946; P = 0.009) and transplant-related mortality (HR 2.320; 95% CI, 1.169–4.426; P = 0.044). Our results, for the first time, suggest an association of DSAs with PT after unmanipulated HBMT. It would help screen out the suitable donor and guide intervention. This indicated that DSAs should be incorporated in the algorithm for unmanipulated HBMT.

The role of collateral related donors in haploidentical hematopoietic stem cell transplantation

“…We also observed that the patients in FDMR CRD group showed low platelet engraftment rate, and the risk of platelet engraftment failure of FDMR CRD group was significantly higher than that of MD group. Zhao et al [32] observed that compared to cases with prolonged thrombocytopenia, patients without prolonged thrombocytopenia had lower incidence of NRM (16.3% vs. 32.5%, P = 0.043), higher probabilities of DFS (74.7% vs. 56.3%, P = 0.046) and OS (75.2% vs. 56.3%, P = 0.047) after haplo-HSCT. Multivariate analysis showed that the onset of prolonged thrombocytopenia was independently associated with NRM (HR = 2.7; P = 0.005).…”

Change of apheresis device decreased the incidence of severe acute graft‐versus‐host disease among patients after allogeneic stem cell transplantation with sibling donors

“…The occurrence of possible immunized donors and female‐to‐male mismatches were also similar between Cobe and Optia (Table ). Other studies have shown a potential effect of DSA on clinical outcomes after HSCT . We have no method in our clinical setting for the detection of DSA against minor antigens.…”

“…Other studies have shown a potential effect of DSA on clinical outcomes after HSCT. 35,36 We have no method in our clinical setting for the detection of DSA against minor antigens.…”

Donor selection for haploidentical hematopoietic cell transplantation‐ practice guidance

“…Moreover, the presence of DSAs is also associated with increased NRM. Zhao et al also found that the presence of DSAs increased the occurrence of prolonged thrombocytopenia after haplo‐HCT …”