The role of HLA antibodies in allogeneic SCT: is the ‘type-and-screen’ strategy necessary not only for blood type but also for HLA?

• Published in: Bone marrow transplantation (Basingstoke) Vol. 47; no. 12; pp. 1499 - 1506
• Main Authors: Yoshihara, S, Taniguchi, K, Ogawa, H, Saji, H
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.12.2012; Nature Publishing Group
• Subjects: 631/250/2152/2153/1291; 692/700/565/545/576/1955; ABO Blood-Group System - immunology; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Animals; Antibodies; Antibodies - immunology; Biological and medical sciences; Blood Grouping and Crossmatching; Blood groups; Bone marrow; Bone marrow transplantation; Bone marrow, stem cells transplantation. Graft versus host reaction; Cell Biology; Cord blood; Donors; Failure; Graft rejection; Grafting; Grafts; Hematology; Hematopoietic Stem Cell Transplantation - methods; Histocompatibility antigen HLA; Histocompatibility antigens; HLA Antigens - immunology; HLA histocompatibility antigens; Humans; Internal Medicine; Medical sciences; Medicine; Medicine & Public Health; Patients; Physiological aspects; Public Health; Rejection; review; Stem cell transplantation; Stem Cells; Tissue Donors; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation Immunology; Transplantation, Homologous; Viral antibodies; Japan; haploidentical transplantation; graft failure; HLA antibodies; cord blood transplantation; solid-phase immunoassays; HLA-System; Haploidentical graft; Hematology; Antibody; Stem cell; Major histocompatibility system; Hematopoietic cell; Homograft; Medical screening; Blood; Graft failure; Immunological method; Blood cell; Allogeneic hematopoietic stem cell transplantation; Umbilical cord; Solid phase
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2011.249

The role of HLA antibodies in SCT has drawn increasing attention because of the significantly increased number of patients who receive HLA-mismatched SCT, including cord blood transplantation, haploidentical SCT and unrelated SCT. Technical advancements in the methods of HLA Ab testing have realized rapid, accurate and objective identification, as well as quantification of specific HLA antibodies. Recent clinical studies have suggested that the presence of donor-specific HLA antibodies (DSA) in patients is associated with graft failure in HLA-mismatched SCT when the above-listed stem cell sources are used and results in different impacts. Of note, most of the ‘HLA-matched’ unrelated SCT actually involve HLA mismatches in HLA-DP and the presence of antibodies against this locus has been reported to be associated with graft failure. Thus, HLA Ab should be examined as a work-up for all patients who undergo SCT from ‘alternative donors.’ The simplest route for preventing HLA Ab-mediated graft failure in Ab-positive patients is to avoid donors who possess the target Ag of HLA antibodies. If SCT from such donors must be performed, treatment for DSA before SCT may improve the chances of successful donor engraftment.