Outcomes of Hematopoietic Stem Cell Transplantation in Patients With Thalassemia Major: How Do Anti-HLA Antibodies Impact?

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2024-11-27 DOI:10.1111/ctr.70035

Gizem Zengin Ersoy, Basak Adakli Aksoy, Melek Erdem, Lokman Karataş, Selime Aydoğdu, Özlem Başoğlu Öner, Gürcan Dikme, Ceyhun Bozkurt, Tunç Fışgın

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Abstract

Aim

To investigate the effects of anti-human Leucocyte Antigen (HLA) antibody positivity on early hematopoietic stem cell transplantation (HSCT) results in patients with thalassemia major (TM).

Methods

One hundred and twenty-four HLA-matched HSCTs were performed in patients with TM between 2015 and 2022. Ninety-one patients were screened for anti-HLA antibodies by testing panel reactive antigens (PRA). Demographic and transplantation characteristics of patients were recorded. The presence of PRA was tested with the Antibody Testing Assay (Luminex LIFECODES HLA Antibody Identification System).

Results

The number of PRA-positive patients was 54. There was no relationship between acute graft versus host disease (GVHD), chronic GVHD, grade of GVHD, and viral reactivation of the patients. However, platelet engraftment took around 3 days longer in the PRA-positive group (p = 0.05). The median number of erythrocyte transfusions was significantly higher in PRA-positive patients in the post-transplant period (p = 0.003), as was the median number of platelet transfusions (p = 0.003). Treosulfan conditioning increased the stable mixed chimerism (MC) rate by 3.8-fold (p = 0.011). In contrast, reduced rates of MC were found in patients who received matched unrelated donor cells or peripherally derived stem cells (p = 0.011 and p = 0.039, respectively) in the posttransplantation period in TM patients. PRA-positivity did not affect MC (p = 0.478). However, 80% of patients who had primary graft failure (n = 5; p = 0.59) and 75% of patients who died (n = 4) were PRA positive (p = 0.64), but these results were statistically insignificant due to the low number of patients.

Conclusion

Anti-HLA antibodies primarily delayed platelet engraftment in TM patients and increased the erythrocyte and thrombocyte transfusion requirements. Although PRA positivity was more common in patients with primary graft failure or who died, there was no statistically significant impact of PRA positivity on chimerism, acute or chronic GVHD, viral activation, or mortality rates.

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重型地中海贫血患者的造血干细胞移植结果：抗-HLA抗体如何影响？抗-HLA抗体对重型地中海贫血移植结果的影响。

目的：研究抗人类白细胞抗原（HLA）抗体阳性对重型地中海贫血（TM）患者早期造血干细胞移植（HSCT）结果的影响：2015年至2022年期间，为重型地中海贫血患者进行了124例HLA匹配造血干细胞移植。通过检测面板反应抗原（PRA）筛查了91名患者的抗HLA抗体。记录了患者的人口统计学特征和移植特征。使用抗体检测试剂盒（Luminex LIFECODES HLA 抗体识别系统）检测是否存在 PRA：结果：PRA阳性患者人数为54人。急性移植物抗宿主疾病（GVHD）、慢性 GVHD、GVHD 级别和患者的病毒再激活之间没有关系。不过，PRA 阳性组的血小板移植时间延长了约 3 天（P = 0.05）。PRA 阳性患者在移植后输注红细胞的中位数明显增加（p = 0.003），输注血小板的中位数也是如此（p = 0.003）。特罗硫安治疗使稳定的混合嵌合体（MC）率增加了 3.8 倍（p = 0.011）。相比之下，在TM患者移植后期间，接受匹配的非亲属供体细胞或外周衍生干细胞的患者的MC率降低（分别为p = 0.011和p = 0.039）。PRA阳性并不影响MC（p = 0.478）。然而，80%的原发性移植失败患者（n = 5；p = 0.59）和75%的死亡患者（n = 4）均为PRA阳性（p = 0.64），但由于患者人数较少，这些结果在统计学上并不显著：结论：抗 HLA 抗体主要延迟了 TM 患者的血小板移植，增加了红细胞和血小板输注需求。虽然 PRA 阳性在原发性移植物失败或死亡的患者中更为常见，但 PRA 阳性对嵌合体、急性或慢性 GVHD、病毒激活或死亡率并无统计学意义。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.