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Abstract：
UNASSIGNED: Hematopoietic stem cell transplantation (HSCT) is curative for patients with sickle cell disease (SCD). Prior to HSCT, patients with SCD commonly receive RBC transfusions with some becoming RBC or HLA alloimmunized. This alloimmunization may impact post-HSCT transfusion requirements and donor engraftment.
UNASSIGNED: The study population included patients with SCD transplanted on a single-center nonmyeloablative, HLA-matched sibling HSCT trial at the National Heart, Lung, and Blood Institute (NHLBI) who had a pre-HSCT sample available for HLA class I antibody testing. We evaluated transfusion requirements and engraftment outcomes comparing patients with and without pre-existing HLA and RBC antibodies.
UNASSIGNED: Of 36 patients studied, 10 (28%) had HLA class I antibodies and 11 (31%) had a history of RBC alloantibodies. Up to day +45 post-HSCT, patients with HLA antibodies received more platelet transfusions (median 2.5 vs 1, p = 0.042) and those with RBC alloantibodies received more RBC units (median 7 vs 4, p = 0.0059) compared to respective non-alloimmunized patients. HLA alloimmunization was not associated with neutrophil engraftment, donor chimerism, or graft rejection. However, RBC alloimmunization correlated with a decreased donor T cell chimerism at 1 year (median 24% vs 55%, p = 0.035).
UNASSIGNED: Pre-existing HLA and RBC alloantibodies are clinically significant for patients undergoing HLA-matched nonmyeloablative HSCT. Testing for both HLA and RBC antibodies is important to help estimate transfusion needs peri‑HSCT. The association of lower donor T cell chimerism and pre-existing RBC alloantibodies needs further investigation.
UNASSIGNED: NIH Clinical Center and NHLBI Intramural Research Program (Z99 CL999999, HL006007-11) and the Thrasher Research Fund.
UNASSIGNED: The study population included patients with SCD transplanted on a single-center nonmyeloablative, HLA-matched sibling HSCT trial at the National Heart, Lung, and Blood Institute (NHLBI) who had a pre-HSCT sample available for HLA class I antibody testing. We evaluated transfusion requirements and engraftment outcomes comparing patients with and without pre-existing HLA and RBC antibodies.
UNASSIGNED: Of 36 patients studied, 10 (28%) had HLA class I antibodies and 11 (31%) had a history of RBC alloantibodies. Up to day +45 post-HSCT, patients with HLA antibodies received more platelet transfusions (median 2.5 vs 1, p = 0.042) and those with RBC alloantibodies received more RBC units (median 7 vs 4, p = 0.0059) compared to respective non-alloimmunized patients. HLA alloimmunization was not associated with neutrophil engraftment, donor chimerism, or graft rejection. However, RBC alloimmunization correlated with a decreased donor T cell chimerism at 1 year (median 24% vs 55%, p = 0.035).
UNASSIGNED: Pre-existing HLA and RBC alloantibodies are clinically significant for patients undergoing HLA-matched nonmyeloablative HSCT. Testing for both HLA and RBC antibodies is important to help estimate transfusion needs peri‑HSCT. The association of lower donor T cell chimerism and pre-existing RBC alloantibodies needs further investigation.
UNASSIGNED: NIH Clinical Center and NHLBI Intramural Research Program (Z99 CL999999, HL006007-11) and the Thrasher Research Fund.
摘要：
■造血干细胞移植（HSCT）可治愈镰状细胞病（SCD）患者。在HSCT之前，SCD患者通常接受RBC输血,部分患者接受RBC或HLA同种免疫.这种同种免疫可能会影响HSCT后输血要求和供体移植。
■研究人群包括单中心非清髓性SCD移植的患者，国家心脏HLA匹配的兄弟姐妹HSCT试验，肺，和血液研究所（NHLBI），他们的HSCT前样本可用于HLAI类抗体测试。我们评估了输血需求和植入结果，比较了有和没有预先存在HLA和RBC抗体的患者。
■在研究的36名患者中，10人（28％）具有HLAI类抗体，11人（31％）具有RBC同种抗体史。HSCT后+45天，与未接受同种异体免疫的患者相比,具有HLA抗体的患者接受了更多的血小板输注(中位数2.5vs1,p=0.042),而具有RBC同种抗体的患者接受了更多的RBC单位(中位数7vs4,p=0.0059).HLA同种免疫与中性粒细胞植入无关，供体嵌合体,或移植排斥。然而,红细胞同种免疫与1年供体T细胞嵌合体减少相关（中位数为24％vs55％，p=0.035)。
■对于接受HLA匹配的非清髓性HSCT的患者，预先存在的HLA和RBC同种抗体具有临床意义。HLA和RBC抗体的检测对于帮助估计HSCT周围的输血需求非常重要。较低的供体T细胞嵌合状态和预先存在的RBC同种抗体的关联需要进一步研究。
■NIH临床中心和NHLBI校内研究计划（Z99CL999999，HL006007-11）和Thrasher研究基金。
■研究人群包括单中心非清髓性SCD移植的患者，国家心脏HLA匹配的兄弟姐妹HSCT试验，肺，和血液研究所（NHLBI），他们的HSCT前样本可用于HLAI类抗体测试。我们评估了输血需求和植入结果，比较了有和没有预先存在HLA和RBC抗体的患者。
■在研究的36名患者中，10人（28％）具有HLAI类抗体，11人（31％）具有RBC同种抗体史。HSCT后+45天，与未接受同种异体免疫的患者相比,具有HLA抗体的患者接受了更多的血小板输注(中位数2.5vs1,p=0.042),而具有RBC同种抗体的患者接受了更多的RBC单位(中位数7vs4,p=0.0059).HLA同种免疫与中性粒细胞植入无关，供体嵌合体,或移植排斥。然而,红细胞同种免疫与1年供体T细胞嵌合体减少相关（中位数为24％vs55％，p=0.035)。
■对于接受HLA匹配的非清髓性HSCT的患者，预先存在的HLA和RBC同种抗体具有临床意义。HLA和RBC抗体的检测对于帮助估计HSCT周围的输血需求非常重要。较低的供体T细胞嵌合状态和预先存在的RBC同种抗体的关联需要进一步研究。
■NIH临床中心和NHLBI校内研究计划（Z99CL999999，HL006007-11）和Thrasher研究基金。
