Platelet transfusion refractoriness attributable to HLA antibodies produced by donor‐derived cells after allogeneic bone marrow transplantation from one HLA‐antigen‐mismatched mother

Hatakeyama, Naoki; Hori, Tsukasa; Yamamoto, Masaki; Inazawa, Natsuko; Iesato, Kotoe; Miyazaki, Tôru; Ikeda, Hisami; Tsutsumi, Hiroyuki; Suzuki, Nobuhiro

doi:10.1111/j.1399-3046.2010.01365.x

Cited by 12 publications

(10 citation statements)

References 10 publications

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“…23,24 Interestingly, three of four patients in this study showed a decrease in the platelet count, despite platelet transfusion on the previous day, on at least two occasions after testing HLA antibody-positive. It is difficult to specify the cause of platelet transfusion refractoriness in patients following allo-SCT because multiple factors, including thrombotic microangiopathy and infections, can be responsible for the occurrence of platelet transfusion refractoriness.…”

Section: Discussionmentioning

confidence: 59%

“…However, recently developed solidphase immunoassays, including the Luminex single antigen assays, allow the accurate identification and quantification of specific HLA antibodies, 22 which enable the comparison of the specificity of HLA antibodies between donors and patients. To date, only one report by Hatakeyama et al 23 demonstrated similar specificities between HLA antibodies that emerged in two patients and those found in their donors. Another case report by Nakazawa et al 24 showed that HLA antibodies with multiple specificities were detected in a patient undergoing SCT from an antibodypositive donor, but the specificity of antibodies in the donor could not be identified.…”

Section: Discussionmentioning

confidence: 87%

See 1 more Smart Citation

Donor-derived HLA antibody production in patients undergoing SCT from HLA antibody-positive donors

Taniguchi

Yoshihara

Maruya³

et al. 2012

Bone Marrow Transplant

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 87%

Donor-derived HLA antibody production in patients undergoing SCT from HLA antibody-positive donors

Taniguchi

Yoshihara

Maruya³

et al. 2012

Bone Marrow Transplant

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“…lesser extent, acute GVHD after HSCT from an unrelated donor, in the context of HLA class II mismatch in the GVH direction. To our knowledge, although anti-HLA donor immunization has been implicated in platelet transfusion refractoriness [19][20][21], the correlation with GVHD occurrence has not been evaluated previously.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, anti-HLA antibodies also may be detected in nulliparous females and nontransfused males [17,18], and thus specifically in HSCT donors. Apart from their role in induced platelet transfusion refractoriness [19][20][21], their impact on HSCT outcome has not yet been explored. Theoretically, recipient-specific anti-HLA antibodies (RSAs) might affect the development of GVHD [22].…”

Section: Introductionmentioning

confidence: 99%

Donor Immunization Against Human Leukocyte Class II Antigens is a Risk Factor for Graft-versus-Host Disease

Delbos

Barhoumi

Cabanne

et al. 2016

Biology of Blood and Marrow Transplantation

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The sensitization to HLA antigens is caused mainly by pregnancy and transfusions; however, anti-HLA antibodies also may be detected in nulliparous females and nontransfused males, and thus specifically in hematopoietic stem cell transplantation (HSCT) donors. In such cases, the impact on HSCT outcome is known only for platelet transfusion refractoriness. This study addresses the impact on graft-versus-host disease (GVHD) of anti-HLA antibodies detected in voluntary unrelated donors. Among 100 donor/recipient (D/R) pairs, 33 and 82 showed at least 1 HLA class I and class II mismatch, respectively. Because class II mismatches were more frequent, we focused our detection on anti-class II antibodies, using the Luminex assay. Among 82 HLA class II mismatched D/R pairs, 26 donors (32%) had at least 1 anti-HLA class II antibody detected in peripheral blood. Recipients of a graft from an anti-class II immunized donor had a higher cumulative incidence for a first episode of either acute or chronic GVHD (2- year cumulative incidence, 88% versus 67%; P = .03), which was confirmed in multivariate analysis (hazard ratio, 1.7; P = .04). In particular, according to the National Institutes of Health classification scheme, the cumulative incidence of chronic GVHD was higher in recipients of immunized donors (multivariate hazard ratio, 2.5; P = .02). Identifying specificities of anti-class II antibodies revealed that 13 of 26 alloimmunized donors had recipient-specific antibodies, directed mainly against mismatched HLA-DPB1 alleles. Donor-derived anti-HLA antibodies could be detected in recipients up to at least 6 months post-HSCT, supporting their association with chronic GVHD. Donor immunization against foreign HLA antigens is a new parameter to predict the occurrence of GVHD after HSCT from HLA-mismatched unrelated donors.

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“…70 Moreover, several case reports have suggested the occurrence of donor-derived HLA Ab production that was possibly associated with platelet transfusion refractoriness in these patients. 71,72 Although cellular immunity has been the main focus of the studies in SCT for decades, a revision of the role of humoral immunity may be warranted.…”

Section: Future Directionsmentioning

confidence: 99%

The role of HLA antibodies in allogeneic SCT: is the ‘type-and-screen’ strategy necessary not only for blood type but also for HLA?

Yoshihara

Taniguchi

Ogawa

et al. 2012

Bone Marrow Transplant

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The role of HLA antibodies in SCT has drawn increasing attention because of the significantly increased number of patients who receive HLA-mismatched SCT, including cord blood transplantation, haploidentical SCT and unrelated SCT. Technical advancements in the methods of HLA Ab testing have realized rapid, accurate and objective identification, as well as quantification of specific HLA antibodies. Recent clinical studies have suggested that the presence of donor-specific HLA antibodies (DSA) in patients is associated with graft failure in HLA-mismatched SCT when the above-listed stem cell sources are used and results in different impacts. Of note, most of the 'HLA-matched' unrelated SCT actually involve HLA mismatches in HLA-DP and the presence of antibodies against this locus has been reported to be associated with graft failure. Thus, HLA Ab should be examined as a work-up for all patients who undergo SCT from 'alternative donors.' The simplest route for preventing HLA Ab-mediated graft failure in Ab-positive patients is to avoid donors who possess the target Ag of HLA antibodies. If SCT from such donors must be performed, treatment for DSA before SCT may improve the chances of successful donor engraftment.

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Platelet transfusion refractoriness attributable to HLA antibodies produced by donor‐derived cells after allogeneic bone marrow transplantation from one HLA‐antigen‐mismatched mother

Cited by 12 publications

References 10 publications

Donor-derived HLA antibody production in patients undergoing SCT from HLA antibody-positive donors

Donor-derived HLA antibody production in patients undergoing SCT from HLA antibody-positive donors

Donor Immunization Against Human Leukocyte Class II Antigens is a Risk Factor for Graft-versus-Host Disease

The role of HLA antibodies in allogeneic SCT: is the ‘type-and-screen’ strategy necessary not only for blood type but also for HLA?

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