ROLE OF HLA ANTIBODIES IN ALLOGENIC STEM CELL TRANSPLANTATION-PRE TRANSPLANT ASSESSMENT AND POST TRANSPLANT MONITORING
Abstract
Background: Hematopoietic stem cell transplantation is a curative therapy for hematologic malignancies/
hematological immune disorders. It involves the transplantation of autologous or allogenic multipotent hematopoietic
stem cells derived from bone marrow, peripheral blood or umbilical cord blood.
Aims: To study the prevalence of HLA antibodies in allogeneic HSCT recipients & monitor their post-transplant
development of anti-HLA antibodies at different time points with their pre/post transplant correlation to engraftment or
graft failure or other transplant outcome
Study design: We carried out the prospective observational study in fifteen cases of allogeneic HSCT over a period of 18
months in a Tertiary Care Superspeciality Hospital of Northern India
Subjects & methods: Flowcytometry based crossmatch & flow PRA (Class I/Class II) was used for pre-transplant & posttransplant
HLA class I and class II cases. Antidonor antibodies were detected by complement dependent
lymphocytoxicity (CDC) cross match and multiple short tandem repeat (STR) amplification methods using fluorescence
labeled PCR combined with capillary electrophoresis.
Statistical Analysis Used: Mean+SD, Mcnemar’s Chi-square tests were used for seeing the agreement between pre &
post-transplant at different time points. P value <0.05 was considered significant and statistical analyses were performed
using SPSS version 21.0.
Results: During the post transplantation follow up for at least 90 days, 4 out of 15 patients succumbed. A total of 13
patients (86.7 %) achieved sustained myeloid engraftment. The cumulative incidence of primary GF was 13.3 % and
included GR (N =2). The three months overall survival (OS) was 80% with 95% CI of 306.74 - 520.11 and a mean of 413.43
days as shown in Kaplan Meier curve. It is proposed that sensitized patients who possess anti-HLA antibodies before or
after the transplantation could benefit from modification of conditioning and immunosuppressive therapeutic
approaches in the future
Keywords
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