The Role of Pre-existing Anti-HLA Antibodies in Severe Aplastic Anemia Patients Undergoing Allogenic Hematopoietic Stem Cell Transplantation

Xiya Wei; Wenjuan Zhu; Jing Li; Shiyuan Zhou; Qian Zhu; Xiao Ma; Yue Han; Ying Wang; Miao Miao; Huiying Qiu; Depei Wu; Xiaojin Wu

doi:10.1016/j.jtct.2024.05.008

The Role of Pre-existing Anti-HLA Antibodies in Severe Aplastic Anemia Patients Undergoing Allogenic Hematopoietic Stem Cell Transplantation

Transplant Cell Ther. 2024 May 11:S2666-6367(24)00405-6. doi: 10.1016/j.jtct.2024.05.008. Online ahead of print.

Authors

Xiya Wei¹, Wenjuan Zhu¹, Jing Li¹, Shiyuan Zhou¹, Qian Zhu¹, Xiao Ma¹, Yue Han¹, Ying Wang¹, Miao Miao¹, Huiying Qiu¹, Depei Wu¹, Xiaojin Wu²

Affiliations

¹ The First Affiliated Hospital of Soochow University, Suzhou, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.
² The First Affiliated Hospital of Soochow University, Suzhou, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China. Electronic address: wuxiaojin@suda.edu.cn.

PMID: 38740139
DOI: 10.1016/j.jtct.2024.05.008

Abstract

The objective is to underscore the significance of pre-existing anti-HLA Abs in the context of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for SAA. A retrospective analysis was conducted using data from 244 SAA patients who underwent allo-HSCT between January 2016 and October 2022. The patient cohort was divided into 2 groups based on the presence of pre-existing anti-HLA Abs. Out of 244 SAA patients, 82 were tested positive for anti-HLA Abs. Seventeen patients were tested with DSA in haplo-HSCT. We found that the presence of pre-existing anti-HLA Abs did not influence neutrophil engraftment (P = .600); however, it resulted in delayed platelet recovery (P = .006). Comparatively, patients with anti-HLA Abs demonstrated lower overall survival (OS) compared to their counter parts without anti-HLA Abs (P = .001), with a correspondingly elevated transplant-related mortality (TRM) in the former group (P = .002). Multivariate analysis established pre-existing anti-HLA Abs as an independent risk factor for impaired platelet recovery (HR 1.67, 95% CI 1.16 to 2.44, P = .006) and OS (HR 2.19, 95% CI 1.03 to 4.67, P = .043). However, there were no differences between DSA and non-DSA patients after desensitization in haplo-HSCT. In summary, the presence of pre-existing anti-HLA Abs in SAA patients undergoing allo-HSCT appears to detrimentally affect platelet recovery and overall prognosis.

Keywords: Allo-HSCT; Anti-HLA Abs; Severe aplastic anemia.