Impact of donor-specific anti-HLA antibodies on graft failure and survival after reduced intensity conditioning-unrelated cord blood transplantation: a Eurocord, Société Francophone d’Histocompatibilité et d’Immunogénétique (SFHI) and Société Française de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC) analysis
Annalisa Ruggeri,
Vanderson Rocha,
Emeline Masson,
Myriam Labopin,
Renato Cunha,
Lena Absi,
Ali Boudifa,
Brigitte Coeffic,
Anne Devys,
Muriel De Matteis,
Valérie Dubois,
Daniel Hanau,
Françoise Hau,
Isabelle Jollet,
Dominique Masson,
Beatrice Pedron,
Pascale Perrier,
Christophe Picard,
Annie Ramouneau-Pigot,
Fernanda Volt,
Dominique Charron,
Eliane Gluckman,
Pascale Loiseau
Affiliations
Annalisa Ruggeri
Eurocord, Hôpital Saint Louis APHP, University Paris VII IUH Paris, France;Rome Transplant Network, University Tor Vergata, Rome, Italy
Vanderson Rocha
Eurocord, Hôpital Saint Louis APHP, University Paris VII IUH Paris, France
Emeline Masson
Laboratory of Immunology and Histocompatibility, Hôpital Saint Louis AP-HP, Paris, France
Myriam Labopin
Acute Leukemia Working Party, EBMT, Hôpital Saint Antoine, Paris, France
Renato Cunha
Eurocord, Hôpital Saint Louis APHP, University Paris VII IUH Paris, France
Lena Absi
Laboratory of Histocompatibility, EFS Auvergne Loire, Saint Etienne, France
Ali Boudifa
Laboratory of Immunology, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
Brigitte Coeffic
Laboratory of Histocompatibility, EFS Pays de la Loire, Angers, France
Anne Devys
Laboratory of Histocompatibility, EFS Pays de la Loire, Nantes, France
Muriel De Matteis
Laboratory of Immunology, CHU Nice, France
Valérie Dubois
Laboratory of Histocompatibility, EFS Rhone Alpes, Lyon, France
Daniel Hanau
Laboratory of Histocompatibility, EFS Alsace, Strasbourg, France
Françoise Hau
Laboratory of Histocompatibility, EFS Normandie, Rouen, France
Isabelle Jollet
Laboratory of Histocompatibility, EFS CA, Poitiers, France
Dominique Masson
Laboratory of Histocompatibility, EFS Rhône Alpes, Grenoble, France
Beatrice Pedron
Laboratory of Immunology, Hôpital Robert Debré, AP-HP, Paris, France
Pascale Perrier
Laboratory of Histocompatibility, CHU Nancy Brabois, Nancy, France
Christophe Picard
Laboratory of Histocompatibility, EFS Alpes Mediterrannée, Marseille, France
Annie Ramouneau-Pigot
Laboratory of Immunology, Hôpital Saint-Eloi, Montpellier, France
Fernanda Volt
Eurocord, Hôpital Saint Louis APHP, University Paris VII IUH Paris, France
Dominique Charron
Laboratory of Immunology and Histocompatibility, Hôpital Saint Louis AP-HP, Paris, France
Eliane Gluckman
Eurocord, Hôpital Saint Louis APHP, University Paris VII IUH Paris, France
Pascale Loiseau
Laboratory of Immunology and Histocompatibility, Hôpital Saint Louis AP-HP, Paris, France
Graft failure is a major complication after unrelated cord blood transplantation. Presence of HLA-antibodies before cord blood transplantation may impact graft failure. To analyze the effect of anti-HLA antibodies on unrelated cord blood transplantation outcomes, we analyzed 294 unrelated cord blood transplant recipients after reduced intensity conditioning regimen. The majority of the patients (82%) were transplanted for malignancies, 60% with double-unrelated cord blood transplant, 63% were HLA mismatched. Retrospectively, pre-unrelated cord blood transplant serum was tested for HLA-Ab using Luminex™ platform. Results were interpreted as mean fluorescence intensity (MFI) against donor-specific mismatch. Among 62 recipients (23%) who had anti-HLA antibodies before unrelated cord blood transplant, 14 patients had donor specific anti-HLA antibodies (DSA) (7 were donor-specific anti-HLA antibodies for single unrelated cord blood transplant and 7 for double unrelated cord blood transplant). Donor specific anti-HLA antibodies threshold ranged from 1620–17629 of mean fluorescence intensity (MFI). Cumulative incidence of Day-60 neutrophil engraftment was 76%: 44% for recipients with donor specific anti-HLA antibodies and 81% in those without donor specific anti-HLA antibodies (P=0.006). The cumulative incidence of 1-year transplant related mortality was 46% in patients with donor specific anti-HLA antibodies and 32% in those without antibodies (P=0.06). The presence of donor specific anti-HLA antibodies was associated with a trend for decreased survival rate (42% vs. 29%; P=0.07). Donor specific anti-HLA antibody in recipients of unrelated cord blood transplant is associated with graft failure and decreased survival. Patient’s screening for donor specific anti-HLA antibodies before unrelated cord blood transplantation is recommended before choosing an HLA mismatched cord blood unit. Whenever possible it is important to avoid selecting a unit for which the patient has donor specific anti-HLA antibodies.
