Abstract
Preformed anti-HLA antibodies (AHA) are known to be associated with delayed engraftment and reduced overall survival after adult hematopoietic stem cell transplantation. However, limited data is available in pediatric patients. In this study, we explored the role of AHA on clinical outcomes in 70 pediatric patients who received a single unit of HLA mismatch cord blood for hematologic malignancies, immunodeficiencies or metabolic diseases. The presence of AHA was detected in 44% (31/70) of the patients. Preformed class I AHA was associated with an increased occurrence of grade 1–4 acute graft-versus host disease (p<0.05). The presence of anti- major-histocompatibility-complex class I–related chain A antigens (MICA) antibodies was significantly associated with a reduced platelet recovery after transplantation (p<0.05). AHA of class II with the strength of antibody titer measured as the mean fluorescence intensity above 2000 was associated with reduced event-free survival (p<0.05). A reduction of high titer of AHA and anti-MICA antibodies might have to be considered before cord blood transplantation in pediatric patients for better outcomes.
Highlights
The presence of preformed anti-HLA antibodies (AHA) is a risk factor for antibody mediated rejection and is associated with reduced clinical outcomes in solid organ transplantation, especially in kidney transplantation [1,2,3,4,5,6]
We have demonstrated the interest of detecting preformed AHA and anti-major-histocompatibility-complex class I–related chain A antigens (MICA) antibodies in a pediatric cohort receiving cord blood unit transplantation
Our data shows the importance of preformed anti-MICA antibodies, which appears to be associated with lower cumulative incidences and prolonged times to platelet recovery
Summary
The presence of preformed anti-HLA antibodies (AHA) is a risk factor for antibody mediated rejection and is associated with reduced clinical outcomes in solid organ transplantation, especially in kidney transplantation [1,2,3,4,5,6]. Detection and determination of specific anti-HLA are a part of the preparatory tests performed by the laboratory before kidney transplantation [1]. Investigating the role of AHA in determining clinical outcomes of hematopoietic stem cell transplantation (HSCT) has recently gained interest. The objective of HSCT is to select a complete HLA matched donor, currently more transplants are being performed with partially matched donors with the availability of cell sources from umbilical cord blood, unrelated donors from the worldwide registry and haploidentical donors. To the best of our knowledge clinical relevance of preformed AHA in pediatric transplantations with cord blood as the only source has not been reported until now
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