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.
■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。