Persistence of anti-HLA antibody after cord blood transplantation engraftment in acute myelogenous leukemia: a potential
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CASE REPORT
Persistence of anti-HLA antibody after cord blood transplantation engraftment in acute myelogenous leukemia: a potential marker of minimal residual disease, but not a significant factor in secondary humoral engraftment failure Takumi Hoshino • Satoru Takada • Kenichi Tahara Hiroaki Shimizu • Nahoko Hatsumi • Shuichi Miyawaki • Tohru Sakura
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Received: 15 June 2012 / Revised: 19 February 2013 / Accepted: 19 February 2013 / Published online: 3 March 2013 Ó The Japanese Society of Hematology 2013
Abstract The presence of pre-transplant anti-HLA antibodies in recipients of cord blood transplantation (CBT) is associated with failed engraftment. However, only a small number of studies have reported that recipient-derived antiHLA antibodies persist after CBT and have potential impact on the outcome. Of 61 patients who underwent HLA-mismatched CBT at Saiseikai Maebashi Hospital, three patients were identified as having anti-HLA antibodies not corresponding to HLA antigens in the transplanted CB. All patients achieved successful engraftment. However, the three patients with the pre-transplant antiHLA antibodies not corresponding to HLA antigens in the transplanted CB continued to produce these antibodies even after engraftment; the persistence of these antibodies served as a sensitive minimal residual disease (MRD) marker. In contrast, donor HLA-specific and newly produced third party antibodies were not detectable even after relapse. The persistence of anti-HLA antibodies even after engraftment may be a potential marker for MRD, but is not a significant factor in secondary humoral engraftment failure.
T. Hoshino (&) S. Takada K. Tahara H. Shimizu N. Hatsumi S. Miyawaki T. Sakura Leukemia Research Center, Saiseikai Maebashi Hospital, Kamishinden-machi, 564-1, Maebashi, Gunma 371-0821, Japan e-mail: [email protected] T. Hoshino K. Tahara H. Shimizu Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, Maebashi, Japan S. Miyawaki Transfusion Service, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan
Keywords Anti-HLA antibody Post-transplant Cord blood transplantation Donor-specific antibody Minimal residual disease Humoral engraftment failure Abbreviations CBT Cord blood transplantation RTX Rituximab PP Plasma pheresis IVIg Polyclonal intravenous immunoglobulin TAC Tacrolimus
Introduction Several studies have demonstrated that the presence of pretransplant anti-HLA antibodies in recipients of HLAmismatched SCT, particularly in cord blood transplantation (CBT), is associated with failed engraftment [1–4]. Takanashi et al. [4] reported that 23.1 % of CBT recipients were antibody-positive and 5.2 % had specificity against the CB HLA. Only a few studies, however, have reported that protracted anti-HLA antibodies will persist after CBT and have potential impact on the outcome [5, 6]. From 2000 to 2010, 61 patients underwent HLA-mismatched CBT at Saiseikai Maebashi Hospital. Three female patients, who were all multiparas, were identified as h
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