Class I and II human leukocyte antibodies in pediatric haploidentical allograft candidates: prevalence and risk factors

• Published in: Bone marrow transplantation (Basingstoke) 2019-08, Vol.54 (8), p.1287-1294
• Main Authors: Lv, Meng, Zhai, Shu-Zhen, Wang, Yu, Xu, Lan-Ping, Zhang, Xiao-Hui, Chen, Huan, Chen, Yu-Hong, Wang, Feng-Rong, Han, Wei, Sun, Yu-Qian, Cheng, Yi-Fei, Yan, Chen-Hua, Mo, Xiao-Dong, Liu, Kai-Yan, Chang, Ying-Jun, Huang, Xiao-Jun, Zhao, Xiang-Yu
• Format: Article
• Language: English
• Subjects: 631/250/1854/2812; 692/308/575; 82/1; Acute lymphoblastic leukemia; Antibodies; Antigens; Bone marrow; Cell Biology; Graft rejection; Grafts; Hematological diseases; Hematology; Histocompatibility antigen HLA; Immunoglobulin G; Immunoglobulins; Incidence; Internal Medicine; Leukemia; Leukocytes; Lymphatic leukemia; Medicine; Medicine & Public Health; Multivariate analysis; Myelodysplastic syndrome; Pediatrics; Public Health; Risk analysis; Risk factors; Stem cell transplantation; Stem Cells; Transplantation
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/s41409-018-0427-7

Donor-specific anti-human leukocyte antigen (HLA) antibodies (DSAs) were associated with graft failure (GF) following haploidentical stem cell transplantation (Haplo-HSCT). The prevalence and risk factors of DSAs in pediatric candidates remain to be determined. In a prospective trial (ChiCTR-OPC-15006672), 486 children with hematological diseases were enrolled to screen for the presence of anti-HLA class I and II antibodies of immunoglobulin G type. Fifty two patients (10.7%) demonstrated positive panel-reactive antibody (PRA) for class I; 24 (4.9%), for class II; and 13 (2.7%), for both. Multivariate analysis showed diagnosis was the independent risk factor for antibodies, as acute lymphoblastic leukemia (ALL) patients (HR0.141, 95% CI: 0.037–0.538, p  = 0.004) had a lower incidence of class II PRAs and DSAs against HLA-B, DQ, and DR, whereas myelodysplastic syndrome (MDS) patients had a higher incidence of PRAs for both class I and class II (HR4.790, 95% CI: 1.010–22.716, p  = 0.049), and DSAs against HLA-A, B, C, DP, and DQ. Older age (>12 vs. ≤12) was associated with DSAs against HLA-DP (HR0.194, 95% CI: 0.041–0.918, p  = 0.039). Our findings provided novel evidence for prevalence and risk factors for PRAs and DSAs in pediatric candidates receiving haplo-HSCT, possibly benefiting anti-HLA antibody monitoring and donor selection.