Donor-specific anti-HLA antibodies predict outcome in double umbilical cord blood transplantation

Abstract

Using a uniform detection method for donor-specific anti-HLA antibodies (DSAs), we sought to determine the effect of preformed DSAs on outcomes in double umbilical cord blood transplantation. DSAs were associated with an increased incidence of graft failure (5.5% vs 18.2% vs 57.1% for none, single, or dual DSA positivity; P = .0001), prolongation of the time to neutrophil engraftment (21 vs 29 days for none vs any DSA; P = .04), and excess 100-day mortality or relapse (23.6% vs 36.4% vs 71.4% for none, single, or dual DSA positivity; P = .01). The intensity of DSA reactivity was correlated with graft failure (median of mean fluorescent intensity 17 650 vs 1 850; P = .039). There was inferior long-term progression-free and overall survival when comparing patients with DSAs against both umbilical cord blood units to those without DSAs (3-year progression-free survival, 0% vs 33.5%, P = .004; 3-year overall survival 0% vs 45.0%, P = .04). We conclude that identification of preformed DSAs in umbilical cord blood recipients should be performed and that the use of umbilical cord blood units where preformed host DSAs exist should be avoided.

Figures

Figure 1

Cumulative incidence of graft failure. The solid line represents no DSAs, the dashed line represents DSAs against one unit, and the dotted line represents DSAs against both units.

Figure 2

Cumulative incidence of neutrophil engraftment. The solid line represents no DSAs, and the dashed line represents DSAs against one or both units.

Figure 3

Cumulative incidence of early death or relapse. The solid line represents no DSAs, the dashed line represents DSAs against one unit; and the dotted line represents DSAs against both units.

Figure 4

Progression-free and overall survival. (A) PFS. (B) OS. The solid line represents no DSAs, and the dashed line represents DSAs against both units.