Untreated Donor-Specific HLA Antibodies Are Associated With Graft Failure and Poor Survival After Haploidentical Transplantation With Post-Transplantation Cyclophosphamide in Pediatric Patients With Nonmalignant Disorders

Lima, Alberto Cardoso Martins; Bonfim, Carmem; Getz, Joselito; Amaral, Geovana Borsato do; Petterle, Ricardo Rasmussen; Loth, Gisele; Nabhan, Samir Kanaan; Marco, Renato de; Gerbase‐DeLima, Maria; Pereira, Noemi F.; Pasqüini, Ricardo

doi:10.1016/j.jtct.2022.07.019

Cited by 9 publications

(2 citation statements)

References 53 publications

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“…Unrelated donor (URD) transplants are the most common alternative, 1 and their use is increasing with the advent of posttransplant cyclophosphamide or abatacept-based graft-versus-host disease prophylaxis. 2 , 3 , 4 This trend may be enhanced by the emerging data that could support the use of younger 8/8 URDs over older sibling donors, 5 the recognition of the limitations associated with older haploidentical donors 6 , 7 or those against whom the patient has donor-specific HLA antibodies, 8 , 9 , 10 and the decline in cord blood transplant activity. 1…”

Section: Introductionmentioning

confidence: 99%

Racial/ethnic disparities in availability of volunteer unrelated donors for allogeneic transplantation

Fingrut,

Davis,

Archer

et al. 2024

Blood Advances

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Despite the global unrelated donor (URD) registry size, the degree to which URD availability is a transplant barrier is not established. We evaluated the availability of 3,843 URDs requested for 455 diverse adult patients (predominantly with acute leukemia). URDs for non-Europeans were more likely to be domestic and had markedly lower Donor Readiness Scores. Of URDs requested for confirmatory HLA-typing (CT) alone (i.e. without simultaneous workup), 1,894/3,529 (54%) were available. Availability of domestic URDs was 45%. Donor Readiness Score was highly predictive of CT availability. Compared with Europeans (n=335), more non-European patients (n=120) had >10 URDs requested and <5 available. Of workup requests (after CT or CT-workup), <70% (604/889, 68%) were available. More non-Europeans had <2 URDs available. URD availability for CT was markedly worse for non-Europeans, with availabilities for African, non-Black Hispanic, and Asian patients of 150/458 (33%), 120/258 (47%) and 119/270 (44%), respectively, with further decrements in URD workup availability. Our data suggest the functional size of the URD pool is much smaller than appreciated, mandating major operational changes for transplant Centers and donor registries. Likelihood of donor availability should have a high priority in donor selection. Considering patient ancestry and URD Donor Readiness Scores, Centers should pursue, and registries permit, simultaneous pursuit of many URDs, and abandon futile searches. Patients should be informed about their likelihood of donor availability and alternative options. Finally, while registries should address high URD attrition and speed procurement, use of all HLA-disparate graft types is needed to facilitate timely transplantation for all.

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Section: Introductionmentioning

confidence: 99%

Racial/ethnic disparities in availability of volunteer unrelated donors for allogeneic transplantation

Fingrut,

Davis,

Archer

et al. 2024

Blood Advances

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“…Primary graft failure (PGF) is a major complication after transplantation associated with adverse outcomes 2 . PGF includes graft rejection (GR), 3 and poor function (PF) of the graft 4 . In comparison, secondary graft failure is defined as the loss of donor cells after initial engraftment, which is more frequent after reduced‐intensity conditioning regimens, and the need for a second transplant is less urgent, as autologous hematopoietic recovery is more likely to occur 5,6 …”

Section: Introductionmentioning

confidence: 99%

Presence of antibodies against HLA class I and class II molecules in children before and after allo‐HSCT. Alloantibodies before and after HSCT

Morán-Espinosa

Ángeles-Floriano

Parra-Ortega

et al. 2022

HLA

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A severe complication of allogeneic hematopoietic stem cell transplantation (HSCT) is graft failure (GF). Among others, donor‐specific anti‐HLA antibodies (DSA) are associated with graft rejection after allogeneic or haploidentical transplantation in adults. Knowledge of DSA and pediatric recipients is limited. Hence, we aimed to generate more information about the presence of DSA (pre‐ and post‐HSCT) and the clinical outcomes (graft rejection and poor function) in children. We identified DSA in 27% of the patients. We observed a higher frequency (50%) of DSA‐bearing patients with a benign disease diagnosis than those diagnosed with leukemia (16.66%). We observed graft rejection in one patient (with DSA against two alleles of HLA class I molecules) and poor function in three recipients during the first 30 days after HSCT in the absence of DSA. The presence of donor and nondonor HLA‐specific antibodies decreased substantially after transplantation. After the transplant, we identified two patients with DSA specific for HLA class I molecules (independent of clinical relevance), and four recipients showed PGF in the absence of DSA. We were unable to establish any association between the presence of DSA and a clinical outcome: graft failure or prevalence of viral infection.

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A Single Centre Experience of Effective Desensitization Strategy for Children with High Anti-HLA Donor-Specific Antibodies Undergoing Haploidentical Hematopoietic Stem Cell Transplantation

Kumar¹,

Bharadwaj²,

Sachan³

et al. 2023

Indian J Hematol Blood Transfus

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Untreated Donor-Specific HLA Antibodies Are Associated With Graft Failure and Poor Survival After Haploidentical Transplantation With Post-Transplantation Cyclophosphamide in Pediatric Patients With Nonmalignant Disorders

Cited by 9 publications

References 53 publications

Racial/ethnic disparities in availability of volunteer unrelated donors for allogeneic transplantation

Racial/ethnic disparities in availability of volunteer unrelated donors for allogeneic transplantation

Presence of antibodies against HLA class I and class II molecules in children before and after allo‐HSCT. Alloantibodies before and after HSCT

A Single Centre Experience of Effective Desensitization Strategy for Children with High Anti-HLA Donor-Specific Antibodies Undergoing Haploidentical Hematopoietic Stem Cell Transplantation

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