Donor-specific anti-HLA antibodies predict outcome in double umbilical cord blood transplantation

Using a uniform detection method for donor-specific anti-HLA antibodies (DSAs), we sought to determine the effect of preformed DSAs on outcomes in double umbilical cord blood transplantation. DSAs were associated with an increased incidence of graft failure (5.5% vs 18.2% vs 57.1% for none, single,...

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Bibliographic Details
Published in:Blood 2011-12, Vol.118 (25), p.6691-6697
Main Authors: Cutler, Corey, Kim, Haesook T., Sun, Lixian, Sese, Doreen, Glotzbecker, Brett, Armand, Philippe, Koreth, John, Ho, Vincent, Alyea, Edwin, Ballen, Karen, Ritz, Jerome, Soiffer, Robert J., Milford, Edgar, Antin, Joseph H.
Format: Article
Language:English
Subjects:
Adult
Aged
Antibodies - immunology
Antibody Specificity - immunology
Biological and medical sciences
Blood Donors
Clinical Trials and Observations
Cord Blood Stem Cell Transplantation - adverse effects
Cord Blood Stem Cell Transplantation - methods
Female
Fetal Blood - immunology
Graft Rejection - immunology
Graft Survival - immunology
Graft vs Host Disease - etiology
Graft vs Host Disease - immunology
Hematologic and hematopoietic diseases
HLA Antigens - immunology
Humans
Kaplan-Meier Estimate
Male
Medical sciences
Middle Aged
Prognosis
Transplantation
Treatment Outcome
Young Adult
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Summary:Using a uniform detection method for donor-specific anti-HLA antibodies (DSAs), we sought to determine the effect of preformed DSAs on outcomes in double umbilical cord blood transplantation. DSAs were associated with an increased incidence of graft failure (5.5% vs 18.2% vs 57.1% for none, single, or dual DSA positivity; P = .0001), prolongation of the time to neutrophil engraftment (21 vs 29 days for none vs any DSA; P = .04), and excess 100-day mortality or relapse (23.6% vs 36.4% vs 71.4% for none, single, or dual DSA positivity; P = .01). The intensity of DSA reactivity was correlated with graft failure (median of mean fluorescent intensity 17 650 vs 1 850; P = .039). There was inferior long-term progression-free and overall survival when comparing patients with DSAs against both umbilical cord blood units to those without DSAs (3-year progression-free survival, 0% vs 33.5%, P = .004; 3-year overall survival 0% vs 45.0%, P = .04). We conclude that identification of preformed DSAs in umbilical cord blood recipients should be performed and that the use of umbilical cord blood units where preformed host DSAs exist should be avoided.
ISSN:0006-4971
1528-0020
DOI:10.1182/blood-2011-05-355263