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Kongtim P, Vittayawacharin P, Zou J, Srour S, Shaffer B, Shapiro RM, Varma A, McGuirk J, Dholaria BR, McCurdy SR, DeZern AE, Bejanyan N, Bashey A, Furst S, Castagna L, Mariotti J, Ruggeri A, Bailen R, Teshima T, Xiao-Jun H, Bonfim C, Aung F, Cao K, Carpenter PA, Hamadani M, Askar M, Fernandez-Vina M, Girnita A, Ciurea SO. ASTCT Consensus Recommendations on Testing and Treatment of Patients with Donor-specific Anti-HLA Antibodies. Transplant Cell Ther 2024:S2666-6367(24)00654-7. [PMID: 39260570 DOI: 10.1016/j.jtct.2024.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Accepted: 09/04/2024] [Indexed: 09/13/2024]
Abstract
Donor-specific anti-HLA antibodies (DSA) are an important cause of engraftment failure and may negatively impact survival outcomes of patients receiving allogeneic hematopoietic stem cell transplantation (HSCT) using an HLA-mismatched allograft. The incidence of DSA varies across studies, depending on individual factors, detection or identification methods and thresholds considered clinically relevant. Although DSA testing by multiplex bead arrays remains semiquantitative, it has been widely adopted as a standard test in most transplant centers. Additional testing to determine risk of allograft rejection may include assays with HLA antigens in natural conformation, such as flow cytometric crossmatch, and/or antibody binding assays, such as C1q testing. Patients with low level of DSA (<2,000 mean fluorescence intensity; MFI) may not require treatment, while others with very high level of DSA (>20,000 MFI) may be at very high-risk for engraftment failure despite current therapies. By contrast, in patients with moderate or high level of DSA, desensitization therapy can successfully mitigate DSA levels and improve donor cell engraftment rate, with comparable outcomes to patients without DSA. Treatment is largely empirical and multimodal, involving the removal, neutralization, and blocking of antibodies, as well as inhibition of antibody production to prevent activation of the complement cascade. Desensitization protocols are based on accumulated multicenter experience, while prospective multicenter studies remain lacking. Most patients require a full intensity protocol that includes plasma exchange, while protocols relying only on rituximab and intravenous immunoglobulin may be sufficient for patients with lower DSA levels and negative C1q and/or flow cytometric crossmatch. Monitoring DSA levels before and after HSCT could guide preemptive treatment when high levels persist after stem cell infusion. This paper aims to standardize current evidence-based practice and formulate future directions to improve upon current knowledge and advance treatment for this relatively rare, but potentially serious complication in allogeneic HSCT recipients.
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Affiliation(s)
- Piyanuch Kongtim
- Hematopoietic Stem Cell Transplant and Cellular Therapy Program, Division of Hematology and Oncology, Department of Medicine, Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, CA, USA
| | - Pongthep Vittayawacharin
- Hematopoietic Stem Cell Transplant and Cellular Therapy Program, Division of Hematology and Oncology, Department of Medicine, Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, CA, USA
| | - Jun Zou
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Samer Srour
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brian Shaffer
- Adult BMT Service, Department of Internal Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Roman M Shapiro
- Department of Medical Oncology, Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ankur Varma
- Section of Bone Marrow Transplant and Cell Therapy, Division of Hematology and Oncology, University of Arkansas for Medical Sciences, Little Rock, AK, USA
| | - Joseph McGuirk
- Hematologic Malignancies and Cellular Therapeutics, The University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Shannon R McCurdy
- Division of Hematology and Oncology and Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadephia, PA, USA
| | - Amy E DeZern
- Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nelli Bejanyan
- Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL, USA
| | - Asad Bashey
- BMT, Acute Leukemia and Cellular Immunotherapy Program at Northside Hospital, Blood and Marrow Transplant Group of Georgia, Atlanta, GA, USA
| | - Sabine Furst
- Programme de Transplantation et d'Immunothérapie Cellulaire, Département d'Hématologie, Institut Paoli Calmettes, Marseille, France
| | - Luca Castagna
- BMT Unit, Ospedale Villa Sofia Cervello, Palermo, Italy
| | - Jacopo Mariotti
- Department of Oncology/Hematology, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Annalisa Ruggeri
- Hematology and BMT unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Rebeca Bailen
- Hematology and Hemotherapy Department, Gregorio Marañon University Hospital, Gregorio Marañon Health Research Institute, Madrid, Spain
| | - Takanori Teshima
- Department of Hematology, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Huang Xiao-Jun
- Peking University Institute of Hematology, Beijing, China
| | - Carmen Bonfim
- Pele Pequeno Principe Research institute/Faculdades Pequeno Principe, Curitiba, Brazil
| | - Fleur Aung
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kai Cao
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Medhat Askar
- College of Medicine, Qatar University, Doha; Qatar and National Marrow Donor Program, Minneapolis, MN
| | | | - Alin Girnita
- HLA Laboratory, Department of Pathology, University of California Irvine, Irvine, CA, USA
| | - Stefan O Ciurea
- Hematopoietic Stem Cell Transplant and Cellular Therapy Program, Division of Hematology and Oncology, Department of Medicine, Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, CA, USA.
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Cruz-Beltran S, Lane A, Seth S, Miller K, Moore RH, Sullivan HC, Fasano RM, Guzzetta NA. Antibodies to human leukocyte antigens and their association with blood product exposures in pediatric patients undergoing cardiac transplantation. Paediatr Anaesth 2021; 31:1065-1073. [PMID: 34363427 DOI: 10.1111/pan.14269] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 07/26/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Previous blood product exposures may result in the development of antibodies to human leukocyte antigens (HLA). Pediatric heart transplant recipients who have these antibodies experience increased morbidity and mortality after transplantation. In this study, our aims were to confirm the association of previous allogeneic blood product exposures with the formation of anti-HLA antibodies, determine which blood components pose the greatest risk of developing antibodies, and assess differences in outcomes after transplantation between patients who had anti-HLA antibodies and those who did not. METHODS This retrospective investigation included all children who underwent cardiac transplantation at Children's Healthcare of Atlanta from January 1, 2015 through December 31, 2018. Chart reviews were performed to collect pertinent data. Anti-HLA antibodies were detected by single antigen bead testing. Antibody burden was tabulated using the calculated panel reactive antibody (cPRA) score immediately prior to transplantation. Statistical analyses were conducted to examine differences based on HLA antibody status and identify associations with outcomes of interest. RESULTS Our results show a significant association between pretransplant blood product exposures and HLA antibody status. Children with a pretransplant blood product exposure had 7.98 times the odds of developing an anti-HLA antibody compared to those without a pretransplant blood product exposure (p = .01). We also found a significant association between a previous red blood cell (RBC) exposure and HLA antibody status (p = .01) which was not found for other blood component exposures. Patients who were HLA antibody positive were more likely to develop a donor-specific antibody (DSA) after transplantation (p = .04). CONCLUSIONS Exposure to previous allogeneic blood products affects the development of anti-HLA antibodies in children presenting for heart transplantation. Previous RBC exposures resulted in HLA antibody positivity more than other blood component exposures. Importantly, the presence of HLA antibodies was associated with the development of DSAs post-transplantation. Developing transfusion strategies to reduce allogeneic blood product exposures in children who may need future cardiac transplantation should be a high priority.
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Affiliation(s)
- Susana Cruz-Beltran
- Department of Anesthesiology, University of Florida, Gainesville, Florida, USA
| | - Andrea Lane
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Shivani Seth
- Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Kati Miller
- Department of Clinical Research, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Reneé H Moore
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Harold C Sullivan
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ross M Fasano
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nina A Guzzetta
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA.,Division of Pediatric Anesthesiology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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Coombs J, Ben Hassen L, Leclerc M, Tamagne M, Pannetier L, Khelfa M, Delorme A, Bocquet T, Maury S, Pirenne F, Ansart‐Pirenne H, Vingert B. Dominant immune response to HLA‐B57/B58 molecules after platelet transfusion. Transfusion 2020; 60:2807-2814. [DOI: 10.1111/trf.16116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/31/2020] [Accepted: 07/31/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Justine Coombs
- Etablissement Français du Sang Ivry sur Seine France
- Institut Mondor de Recherche Biomédicale Créteil France
- Laboratory of Excellence GR‐Ex Paris France
| | - Latifa Ben Hassen
- Etablissement Français du Sang Ivry sur Seine France
- Institut Mondor de Recherche Biomédicale Créteil France
- Laboratory of Excellence GR‐Ex Paris France
| | - Mathieu Leclerc
- AP‐HP ‐ Hôpital Henri Mondor Créteil France
- Université Paris Est Faculté de médecine Créteil France
| | - Marie Tamagne
- Etablissement Français du Sang Ivry sur Seine France
- Institut Mondor de Recherche Biomédicale Créteil France
- Laboratory of Excellence GR‐Ex Paris France
| | - Louise Pannetier
- Etablissement Français du Sang Ivry sur Seine France
- Institut Mondor de Recherche Biomédicale Créteil France
- Laboratory of Excellence GR‐Ex Paris France
| | - Mehdi Khelfa
- Etablissement Français du Sang Ivry sur Seine France
- Institut Mondor de Recherche Biomédicale Créteil France
- Laboratory of Excellence GR‐Ex Paris France
| | - Adèle Delorme
- Etablissement Français du Sang Ivry sur Seine France
- Institut Mondor de Recherche Biomédicale Créteil France
- Laboratory of Excellence GR‐Ex Paris France
| | | | - Sébastien Maury
- AP‐HP ‐ Hôpital Henri Mondor Créteil France
- Université Paris Est Faculté de médecine Créteil France
| | - France Pirenne
- Etablissement Français du Sang Ivry sur Seine France
- Institut Mondor de Recherche Biomédicale Créteil France
- Laboratory of Excellence GR‐Ex Paris France
- Université Paris Est Faculté de médecine Créteil France
| | | | - Benoît Vingert
- Etablissement Français du Sang Ivry sur Seine France
- Institut Mondor de Recherche Biomédicale Créteil France
- Laboratory of Excellence GR‐Ex Paris France
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Yusoff SM, Bahar R, Hassan MN, Noor NHM, Ramli M, Shafii NF. Prevalence of Red Blood Cell Alloimmunization among Transfused Chronic Kidney Disease Patients in Hospital Universiti Sains Malaysia. Oman Med J 2020; 35:e177. [PMID: 33083035 PMCID: PMC7538639 DOI: 10.5001/omj.2020.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/01/2020] [Indexed: 01/19/2023] Open
Abstract
Objectives Red blood cell (RBC) immunization is a common complication in blood transfusion recipients. Patients with chronic kidney disease (CKD) eventually develop anemia, which is multifactorial, and requires regular blood transfusions, which exposes patients to the development of RBC antibodies. We sought to determine the prevalence and specificity patterns of RBC immunization and its risk factors among transfused CKD patients. Methods We conducted a cross-sectional study over one year from January to December 2018 in the Transfusion Medicine Unit, Hospital Universiti Sains Malaysia. A total of 249 samples were recruited from CKD patients who received a blood transfusion (at least one-pint), which only match for ABO and Rh(D) antigen. The serum was screened for the presence of the RBC antibody using the gel agglutination technique (Diamed gel cards). Samples with positive antibody screening were subjected to antibody identification. Results Of the 249 transfused CKD patients, 31 (12.4%) developed RBC immunization. Thirty (12%) were alloimmunized, and one (0.4%) was autoimmunized. Anti-Mia was the most common antibody (n = 14, 46.7%) among alloantibodies, followed by anti-E (n = 7, 23.3%). There was a significant association between pregnancy history with the development of antibodies whereas, no significant association was found between sociodemographic background, stage of CKD, hemodialysis status, underlying medical illness, and number of packed cell transfusions with the development of RBC antibodies. Conclusions One-eighth of our patient cohort had RBC alloimmunization, and the risk was increased in patients with a history of pregnancy. We propose Rhesus RBC phenotyping and to supply blood match Rhesus antigen in CKD patients, especially patients of reproductive age.
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Affiliation(s)
- Shafini Mohamed Yusoff
- Department of Hematology and Transfusion Medicine Unit, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Rosnah Bahar
- Department of Hematology and Transfusion Medicine Unit, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Mohd Nazri Hassan
- Department of Hematology and Transfusion Medicine Unit, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Noor Haslina Mohd Noor
- Department of Hematology and Transfusion Medicine Unit, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Marini Ramli
- Department of Hematology and Transfusion Medicine Unit, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
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Nickel RS, Horan JT, Abraham A, Qayed M, Haight A, Ngwube A, Liang H, Luban NLC, Hendrickson JE. Human leukocyte antigen (HLA) class I antibodies and transfusion support in paediatric HLA‐matched haematopoietic cell transplant for sickle cell disease. Br J Haematol 2019; 189:162-170. [DOI: 10.1111/bjh.16298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 08/19/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Robert S. Nickel
- Division of Hematology Children's National Hospital WashingtonDCUSA
- The George Washington University School of Medicine and Health Sciences Washington DCUSA
| | - John T. Horan
- Aflac Cancer and Blood Disorders Center Emory University Atlanta GAUSA
| | - Allistair Abraham
- Division of Hematology Children's National Hospital WashingtonDCUSA
- The George Washington University School of Medicine and Health Sciences Washington DCUSA
| | - Muna Qayed
- Aflac Cancer and Blood Disorders Center Emory University Atlanta GAUSA
| | - Ann Haight
- Aflac Cancer and Blood Disorders Center Emory University Atlanta GAUSA
| | - Alexander Ngwube
- Center for Cancer and Blood Disorders Phoenix Children's Hospital Phoenix AZUSA
| | - Hua Liang
- Department of Statistics The George Washington University Washington DCUSA
| | - Naomi L. C. Luban
- Division of Hematology Children's National Hospital WashingtonDCUSA
- The George Washington University School of Medicine and Health Sciences Washington DCUSA
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Belizaire R, Mack J, Kadauke S, Kim Y, Saidman S, Makar RS. Red blood cell alloantibodies are associated with increased alloimmunization against human leukocyte antigens. Transfusion 2019; 59:2256-2263. [DOI: 10.1111/trf.15306] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/18/2019] [Accepted: 03/21/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Roger Belizaire
- Department of Pathology, Division of Transfusion MedicineBrigham and Women's Hospital and Harvard Medical School Boston Massachusetts
| | - Johnathan Mack
- Ottawa Hospital Research InstituteUniversity of Ottawa Ottawa Ontario
| | - Stephan Kadauke
- Department of Pathology, Blood Transfusion ServiceMassachusetts General Hospital and Harvard Medical School Boston Massachusetts
| | - Yeowon Kim
- Department of Pathology, Blood Transfusion ServiceMassachusetts General Hospital and Harvard Medical School Boston Massachusetts
| | - Susan Saidman
- Department of Pathology, Histocompatibility LaboratoryMassachusetts General Hospital and Harvard Medical School Boston Massachusetts
| | - Robert S. Makar
- Department of Pathology, Blood Transfusion ServiceMassachusetts General Hospital and Harvard Medical School Boston Massachusetts
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7
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Lv M, Zhai SZ, Wang Y, Xu LP, Zhang XH, Chen H, Chen YH, Wang FR, Han W, Sun YQ, Cheng YF, Yan CH, Mo XD, Liu KY, Chang YJ, Huang XJ, Zhao XY. Class I and II human leukocyte antibodies in pediatric haploidentical allograft candidates: prevalence and risk factors. Bone Marrow Transplant 2019; 54:1287-1294. [DOI: 10.1038/s41409-018-0427-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 11/26/2018] [Accepted: 12/09/2018] [Indexed: 12/13/2022]
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Obi EI, Pughikumo CO, Oko-jaja RI. Red blood cell alloimmunization in multi-transfused patients with chronic kidney disease in Port Harcourt, South-South Nigeria. Afr Health Sci 2018; 18:979-987. [PMID: 30766563 PMCID: PMC6354886 DOI: 10.4314/ahs.v18i4.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Serological safety is an integral part of overall safety for blood banks. OBJECTIVES The aim of the study was to determine the prevalence and specificities of red blood cell alloimmunization in multi-transfused patients with chronic kidney disease (CKD). METHODS A cross-sectional case-control study carried out at the University of Port Harcourt Teaching Hospital in which 186 patients with CKD were enrolled consecutively, 124 had received multiple transfusions (more than one unit of blood in one month, or at least 10 units within 3 months), while 62 had never been transfused. Antibody screen test was performed by the gel agglutination technique. RBC antibody identification was performed on the sera of those that tested positive to antibody screening test. RESULTS Out of the 124 multi-transfused patients (total of 789 transfusions), 4 (3.2%) were alloimmunised. The alloimmunised patients received a higher mean number of 17.5 ± 12 blood units, compared to 6 ± 6 units by the non-alloimmunised multi-transfused patient (p= <0.001). Six clinically significant alloantibodies were identified with all of the alloimmunised patients forming more than one antibody. Anti-E was detected in all alloimmunised patients. CONCLUSION The prevalence of RBC alloimmunisation in multi-transfused CKD patients was 3.2% with anti-E being the most frequently identified antibody.
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Affiliation(s)
- Esther Ifeoma Obi
- Department of Haematology and Blood Transfusion, Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria
| | - Crosdale Ogho Pughikumo
- Department of Haematology and Immunology, College of Health Sciences, Niger Delta University, Wilberforce Island, Bayelsa State, Nigeria
| | - Richard Ishmael Oko-jaja
- Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
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9
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Yee MEM, Josephson CD, Winkler AM, Webb J, Luban NLC, Leong T, Stowell SR, Fasano RM. Red blood cell minor antigen mismatches during chronic transfusion therapy for sickle cell anemia. Transfusion 2017; 57:2738-2746. [PMID: 28840600 DOI: 10.1111/trf.14282] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/08/2017] [Accepted: 06/13/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Red blood cell (RBC) alloimmunization occurs at a high frequency in sickle cell anemia (SCA) despite serologic matching for Rh (C/c, E/e) and K antigens. RBC minor antigen genotyping allows for prediction of antigens and RH variants that may lead to alloimmunization. STUDY DESIGN AND METHODS RBC antigen genotyping was performed on chronically transfused pediatric SCA patients, using PreciseType human erythrocyte antigen (HEA), RHCE, and RHD BeadChip arrays. All patients received C/c, E/e, and K serologically matched units (Category 1); patients with prior RBC antibodies were also matched for Fya , Jkb , and any antibodies (Category 2). The RBC genotypes of all leukoreduced (LR) units transfused over a 12-month period were determined by the prototype HEA-LR BeadChip assay. RESULTS There were 2320 RBC units transfused to 90 patients in 1135 transfusion episodes. Thirty-five (38.9%) patients had homozygous or compound heterozygous RH variants. Seven new alloantibodies were detected, with alloantibody incidence of 0.706 in 100 units for Category 2 transfusions and 0.068 in 100 units for Category 1 (p = 0.02). Three patients on Category 2 transfusions formed new anti-Jsa and had a higher rate of exposure to Jsa than those who did not form anti-Jsa (20.4 vs. 8.33 exposures/100 units, p = 0.02). The most frequent mismatches were S (43.9%), Doa (43.9%), Fya (29.2%), M (28.4%), and Jkb (28.1%). CONCLUSIONS Alloimmunization incidence was higher in those with prior RBC antibodies, suggesting that past immunologic responders are at higher risk for future alloimmunization and therefore may benefit from more extensive antigen matching beyond C/c, E/e, K, Fya , and Jkb .
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Affiliation(s)
- Marianne E M Yee
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics, Division of Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Cassandra D Josephson
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics, Division of Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia.,Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Anne M Winkler
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jennifer Webb
- Center for Cancer and Blood Disorders, Children's National Health System, Departments of Hematology and Laboratory Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Naomi L C Luban
- Center for Cancer and Blood Disorders, Children's National Health System, Departments of Hematology and Laboratory Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Traci Leong
- Department of Biostatistics and Bioinformatics, Emory University, Rollins School of Public Health, Atlanta, Georgia
| | - Sean R Stowell
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Ross M Fasano
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
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Özdoğu H, Boğa C. Hematopoietic Stem Cell Transplantation in Adult Sickle Cell Disease: Problems and Solutions. Turk J Haematol 2017; 32:195-205. [PMID: 25912490 PMCID: PMC4563194 DOI: 10.4274/tjh.2014.0311] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Sickle cell disease-related organ injuries cannot be prevented despite hydroxyurea use, infection prophylaxis, and supportive therapies. As a consequence, disease-related mortality reaches 14% in adolescents and young adults. Hematopoietic stem cell transplantation is a unique curative therapeutic approach for sickle cell disease. Myeloablative allogeneic hematopoietic stem cell transplantation is curative for children with sickle cell disease. Current data indicate that long-term disease-free survival is about 90% and overall survival about 95% after transplantation. However, it is toxic in adults due to organ injuries. In addition, this curative treatment approach has several limitations, such as difficulties to find donors, transplant-related mortality, graft loss, graft-versus-host disease (GVHD), and infertility. Engraftment effectivity and toxicity for transplantations performed with nonmyeloablative reduced-intensity regimens in adults are being investigated in phase 1/2 trials at many centers. Preliminary data indicate that GVHD could be prevented with transplantations performed using reduced-intensity regimens. It is necessary to develop novel regimens to prevent graft loss and reduce the risk of GVHD.
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11
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Nickel RS, Winkler AM, Horan JT, Hendrickson JE. Leukoreduced red blood cell transfusions do not induce platelet glycoprotein antibodies in patients with sickle cell disease. Transfusion 2016; 56:2267-73. [DOI: 10.1111/trf.13693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/10/2016] [Accepted: 05/10/2016] [Indexed: 12/22/2022]
Affiliation(s)
| | - Anne M. Winkler
- Department of Pathology and Laboratory Medicine, Center for Transfusion and Cellular TherapyChildren's Healthcare of Atlanta, Emory UniversityAtlanta Georgia
| | - John T. Horan
- Aflac Cancer and Blood Disorders CenterChildren's Healthcare of Atlanta, Emory UniversityAtlanta Georgia
| | - Jeanne E. Hendrickson
- Department of PediatricsYale UniversityNew Haven Connecticut
- Department of Laboratory MedicineYale UniversityNew Haven Connecticut
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12
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Nickel RS, Hendrickson JE, Yee MM, Bray RA, Gebel HM, Kean LS, Miklos DB, Horan JT. Red blood cell transfusions are associated with HLA class I but not H-Y alloantibodies in children with sickle cell disease. Br J Haematol 2015; 170:247-56. [PMID: 25891976 DOI: 10.1111/bjh.13424] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 02/28/2015] [Indexed: 12/18/2022]
Abstract
Blood transfusions can induce alloantibodies to antigens on red blood cells (RBCs), white blood cells and platelets, with these alloantibodies affecting transfusion and transplantation. While transfusion-related alloimmunization against RBC antigens and human leucocyte antigens (HLA) have been studied, transfusion-related alloimmunization to minor histocompatibility antigens (mHA), such as H-Y antigens, has not been clinically characterized. We conducted a cross-sectional study of 114 children with sickle cell disease (SCD) and tested for antibodies to 5 H-Y antigens and to HLA class I and class II. Few patients had H-Y antibodies, with no significant differences in the prevalence of any H-Y antibody observed among transfused females (7%), transfused males (6%) and never transfused females (4%). In contrast, HLA class I, but not HLA class II, antibodies were more prevalent among transfused than never transfused patients (class I: 33% vs. 13%, P = 0·046; class II: 7% vs. 8%, P = 0·67). Among transfused patients, RBC alloantibody history but not amount of transfusion exposure was associated with a high (>25%) HLA class I panel reactive antibody (Odds ratio 6·8, 95% confidence interval 2·1-22·3). These results are consistent with immunological responder and non-responder phenotypes, wherein a subset of patients with SCD may be at higher risk for transfusion-related alloimmunization.
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Affiliation(s)
- Robert S Nickel
- Aflac Cancer and Blood Disorders Centre, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA.,Department of Pathology, Emory University, Atlanta, GA, USA
| | - Jeanne E Hendrickson
- Departments of Laboratory Medicine and Paediatrics, Yale University, New Haven, CT, USA
| | - Marianne M Yee
- Aflac Cancer and Blood Disorders Centre, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Robert A Bray
- Department of Pathology, Emory University, Atlanta, GA, USA
| | - Howard M Gebel
- Department of Pathology, Emory University, Atlanta, GA, USA
| | - Leslie S Kean
- Aflac Cancer and Blood Disorders Centre, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA.,Ben Towne Centre for Childhood Cancer Research, Seattle Children's Research Institute, Department of Paediatrics, University of Washington, Fred Hutchinson Cancer Research Centre, Seattle, WA, USA
| | - David B Miklos
- Division of Blood and Marrow Transplantation, Stanford University, Stanford, CA, USA
| | - John T Horan
- Aflac Cancer and Blood Disorders Centre, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
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13
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Tatari-Calderone Z, Luban NLC, Vukmanovic S. Genetics of transfusion recipient alloimmunization: can clues from susceptibility to autoimmunity pave the way? ACTA ACUST UNITED AC 2014; 41:436-45. [PMID: 25670931 DOI: 10.1159/000369145] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 10/01/2014] [Indexed: 01/08/2023]
Abstract
The search for genetic determinants of alloimmunization in sickle cell disease transfusion recipients was based on two premises: i) that polymorphisms responsible for stronger immune and/or inflammatory responses and hemoglobin β(S) mutation were co-selected by malaria; and ii) that stronger responder status contributes to development of lupus. We found a marker of alloimmunization in the gene encoding for Ro52 protein, also known as Sjögren syndrome antigen 1 (SSA1) and TRIM21. Surprisingly, the nature of the association was opposite of that with lupus; the same variant of a polymorphism (rs660) that was associated with lupus incidence was also associated with induction of tolerance to red blood cell antigens during early childhood. The dual function of Ro52 can explain this apparent contradiction. We propose that other lupus/autoimmunity susceptibility loci may reveal roles of additional molecules in various aspects of alloimmunization induced by transfusion as well as during pregnancy.
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Affiliation(s)
- Zohreh Tatari-Calderone
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, Washington, DC, USA ; Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA
| | - Naomi L C Luban
- Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA ; Division of Laboratory Medicine, Children's National Medical Center, Washington, DC, USA
| | - Stanislav Vukmanovic
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, Washington, DC, USA ; Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA
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14
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Ryder AB, Zimring JC, Hendrickson JE. Factors Influencing RBC Alloimmunization: Lessons Learned from Murine Models. Transfus Med Hemother 2014; 41:406-19. [PMID: 25670928 PMCID: PMC4280453 DOI: 10.1159/000368995] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 10/01/2014] [Indexed: 01/25/2023] Open
Abstract
Red blood cell (RBC) alloimmunization may occur following transfusion or pregnancy/delivery. Although observational human studies have described the immunogenicity of RBC antigens and the clinical significance of RBC alloantibodies, studies of factors influencing RBC alloimmunization in humans are inherently limited by the large number of independent variables involved. This manuscript reviews data generated in murine models that utilize transgenic donor mice, which express RBC-specific model or authentic human blood group antigens. Transfusion of RBCs from such donors into nontransgenic but otherwise genetically identical recipient mice allows for the investigation of individual donor or recipient-specific variables that may impact RBC alloimmunization. Potential donor-related variables include methods of blood product collection, processing and storage, donor-specific characteristics, RBC antigen-specific factors, and others. Potential recipient-related variables include genetic factors (MHC/HLA type and polymorphisms of immunoregulatory genes), immune activation status, phenotype of regulatory immune cell subsets, immune cell functional characteristics, prior antigen exposures, and others. Although murine models are not perfect surrogates for human biology, these models generate phenomenological and mechanistic hypotheses of RBC alloimmunization and lay the groundwork for follow-up human studies. Long-term goals include improving transfusion safety and minimizing the morbidity/mortality associated with RBC alloimmunization.
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Affiliation(s)
- Alex B. Ryder
- Yale University School of Medicine, Department of Laboratory Medicine, New Haven, CT, USA
| | - James C. Zimring
- Puget Sound Blood Center Research Institute, Seattle, WA, USA
- University of Washington, Department of Laboratory Medicine, Seattle, WA, USA
| | - Jeanne E. Hendrickson
- Yale University School of Medicine, Department of Laboratory Medicine, New Haven, CT, USA
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15
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Peña JRA, Saidman SL, Girouard TC, Meister E, Dzik WH, Makar RS. Anti-HLA alloantibodies in surgical patients refractory to platelet transfusion. Am J Hematol 2014; 89:E133-7. [PMID: 24816643 DOI: 10.1002/ajh.23757] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 05/07/2014] [Accepted: 05/08/2014] [Indexed: 11/11/2022]
Abstract
Alloimmune platelet refractoriness (alloPR) among actively bleeding surgical patients with thrombocytopenia represents a life-threatening problem. Here we present three cases in which surgical bleeding was complicated by life-threatening thrombocytopenia and alloPR. We demonstrate that the human leukocyte antigens (HLA) antibodies associated with alloPR are broadly reactive and in high concentration, are not removed by hemodilution, and are not absorbed by transfusion of multiple doses of platelet concentrates. HLA alloPR may be under-recognized among surgical patients. Research is needed to develop pre-operative screening methods that will identify patients in need of specialized platelet support using HLA compatible donor products.
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Affiliation(s)
- Jeremy Ryan A. Peña
- Division of Laboratory and Transfusion Medicine; Department of Pathology; Beth Israel Deaconess Medical Center; Boston Massachusetts
- Blood Transfusion Service; Department of Pathology; Massachusetts General Hospital; Boston Massachusetts
| | - Susan L. Saidman
- Blood Transfusion Service; Department of Pathology; Massachusetts General Hospital; Boston Massachusetts
| | - Timothy C. Girouard
- Blood Transfusion Service; Department of Pathology; Massachusetts General Hospital; Boston Massachusetts
| | - Erin Meister
- Blood Transfusion Service; Department of Pathology; Massachusetts General Hospital; Boston Massachusetts
| | - Walter H. Dzik
- Blood Transfusion Service; Department of Pathology; Massachusetts General Hospital; Boston Massachusetts
| | - Robert S. Makar
- Blood Transfusion Service; Department of Pathology; Massachusetts General Hospital; Boston Massachusetts
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16
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Vichinsky E, Neumayr L, Trimble S, Giardina PJ, Cohen AR, Coates T, Boudreaux J, Neufeld EJ, Kenney K, Grant A, Thompson AA. Transfusion complications in thalassemia patients: a report from the Centers for Disease Control and Prevention (CME). Transfusion 2013; 54:972-81; quiz 971. [PMID: 23889533 DOI: 10.1111/trf.12348] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 05/06/2013] [Accepted: 06/01/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND Transfusions are the primary therapy for thalassemia but have significant cumulative risks. In 2004, the Centers for Disease Control and Prevention (CDC) established a national blood safety monitoring program for thalassemia. This report summarizes the population and their previous nonimmune and immune transfusion complications. STUDY DESIGN AND METHODS The CDC Thalassemia Blood Safety Network is a consortium of centers longitudinally following patients. Enrollment occurred from 2004 through 2012. Demographics, transfusion history, infectious exposures, and transfusion and nontransfusion complications were summarized. Logistic regression analyses of factors associated with allo- and autoimmunization were employed. RESULTS The race/ethnicity of these 407 thalassemia patients was predominantly Asian or Caucasian. The mean ± SD age was 22.3 ± 13.2 years and patients had received a mean ± SD total number of 149 ± 103.4 units of red blood cells (RBCs). Multiorgan dysfunction was common despite chelation. Twenty-four percent of transfused patients had previous exposure to possible transfusion-associated pathogens including one case of babesia. As 27% were immigrants, the infection source cannot be unequivocally linked to transfusion. Transfusion reactions occurred in 48%, including allergic, febrile, and hemolytic; 19% were alloimmunized. Common antigens were E, Kell, and C. Years of transfusion was the strongest predictor of alloimmunization. Autoantibodies occurred in 6.5% and were associated with alloimmunization (p < 0.0001). Local institutional policies, not patient characteristics, were major determinants of blood preparation and transfusion practices. CONCLUSION Hemosiderosis, transfusion reactions, and infections continue to be major problems in thalassemia. New pathogens were noted. National guidelines for RBC phenotyping and preparation are needed to decrease transfusion-related morbidity.
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Affiliation(s)
- Elliott Vichinsky
- Children's Hospital Oakland, Oakland, California; Centers for Disease Control and Prevention, Atlanta, Georgia; Weill Medical College of Cornell University, New York, New York; Children's Hospital Philadelphia, Philadelphia, Pennsylvania; Children's Hospital Los Angeles, Los Angeles, California; Children's Healthcare of Atlanta at Scottish Rite, Atlanta, Georgia; Boston Children's Hospital, Boston, Massachusetts; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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17
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The association of CD81 polymorphisms with alloimmunization in sickle cell disease. Clin Dev Immunol 2013; 2013:937846. [PMID: 23762099 PMCID: PMC3674646 DOI: 10.1155/2013/937846] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 04/17/2013] [Accepted: 04/18/2013] [Indexed: 01/19/2023]
Abstract
The goal of the present work was to identify the candidate genetic markers predictive of alloimmunization in sickle cell disease (SCD). Red blood cell (RBC) transfusion is indicated for acute treatment, prevention, and abrogation of some complications of SCD. A well-known consequence of multiple RBC transfusions is alloimmunization. Given that a subset of SCD patients develop multiple RBC allo-/autoantibodies, while others do not in a similar multiple transfusional setting, we investigated a possible genetic basis for alloimmunization. Biomarker(s) which predicts (predict) susceptibility to alloimmunization could identify patients at risk before the onset of a transfusion program and thus may have important implications for clinical management. In addition, such markers could shed light on the mechanism(s) underlying alloimmunization. We genotyped 27 single nucleotide polymorphisms (SNPs) in the CD81, CHRNA10, and ARHG genes in two groups of SCD patients. One group (35) of patients developed alloantibodies, and another (40) had no alloantibodies despite having received multiple transfusions. Two SNPs in the CD81 gene, that encodes molecule involved in the signal modulation of B lymphocytes, show a strong association with alloimmunization. If confirmed in prospective studies with larger cohorts, the two SNPs identified in this retrospective study could serve as predictive biomarkers for alloimmunization.
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18
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Evaluation of HLA matching in unrelated hematopoietic stem cell transplantation for nonmalignant disorders. Blood 2012; 120:2918-24. [PMID: 22829628 DOI: 10.1182/blood-2012-03-417758] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The importance of human leukocyte antigen (HLA) matching in unrelated donor transplantation for nonmalignant diseases (NMD) has yet to be defined. We analyzed data from 663 unrelated marrow and peripheral blood stem cell transplants performed from 1995 to 2007 for treatment of NMD. Transplantation from a donor mismatched at the HLA-A, -B, -C, or -DRB1, but not -DQB1 or -DPB1, loci was associated with higher mortality in multivariate analyses (P = .002). The hazard ratio for mortality for single (7/8) and double mismatched (6/8) transplants was 1.29 (0.97-1.72; P = .079) and 1.82 (1.30-2.55; P = .0004), respectively, compared with 8/8 matched transplants. HLA mismatches were not associated with acute or chronic GVHD, but were strongly associated with graft failure. After adjustment for other factors, the odds ratio for graft failure for 7/8 and 6/8 (allele and/or antigen) matched pairs compared with 8/8 matched transplants was 2.81 (1.74-4.54; P < .0001) and 2.22 (1.26-3.97; P = .006), respectively. Patients with NMD should receive transplants from allele matched (8/8) donors if possible. Unlike the case with malignancies, HLA mismatching in NMD is associated with graft failure rather than GVHD.
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19
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Kamani NR, Walters MC, Carter S, Aquino V, Brochstein JA, Chaudhury S, Eapen M, Freed BM, Grimley M, Levine JE, Logan B, Moore T, Panepinto J, Parikh S, Pulsipher MA, Sande J, Schultz KR, Spellman S, Shenoy S. Unrelated donor cord blood transplantation for children with severe sickle cell disease: results of one cohort from the phase II study from the Blood and Marrow Transplant Clinical Trials Network (BMT CTN). Biol Blood Marrow Transplant 2012; 18:1265-72. [PMID: 22343376 DOI: 10.1016/j.bbmt.2012.01.019] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 01/29/2012] [Indexed: 10/28/2022]
Abstract
The Sickle Cell Unrelated Donor Transplant Trial (SCURT trial) of the Blood and Marrow Transplant Clinical Trials Network (BMT CTN) is a phase II study of the toxicity and efficacy of unrelated donor hematopoietic cell transplantation in children with severe sickle cell disease (SCD) using a reduced-intensity conditioning regimen. Here we report the results for the cord blood cohort of this trial. Eight children with severe SCD underwent unrelated donor cord blood transplantation (CBT) following alemtuzumab, fludarabine, and melphalan. Cyclosporine or tacrolimus and mycophenolate mofetil were administered for graft-versus-host disease (GVHD) prophylaxis. Donor/recipient HLA match status was 6 of 6 (n = 1) or 5 of 6 (n = 7), based on low/intermediate-resolution molecular typing at HLA -A, -B, and high-resolution typing at -DRB1. Median recipient age was 13.7 years (range: 7.4-16.2 years), and median weight was 35.0 kg (range: 25.2-90.2 kg). The median pre-cryopreservation total nucleated cell dose was 6.4 × 10(7) /kg (range: 3.1-7.6), and the median postthaw infused CD34 cell dose was 1.5 × 10(5) /kg (range: 0.2-2.3). All patients achieved neutrophil recovery (absolute neutrophil count >500/mm(3)) by day 33 (median: 22 days). Three patients who engrafted had 100% donor cells by day 100, which was sustained, and 5 patients had autologous hematopoietic recovery. Six of 8 patients had a platelet recovery to >50,000/mm(3) by day 100. Two patients developed grade II acute GVHD. Of these, 1 developed extensive chronic GVHD and died of respiratory failure 14 months posttransplantation. With a median follow-up of 1.8 years (range: 1-2.6), 7 patients are alive with a 1-year survival of 100%, and 3 of 8 are alive without graft failure or disease recurrence. Based upon the high incidence of graft rejection after unrelated donor CBT, enrollment onto the cord blood arm of the SCURT trial was suspended. However, because this reduced-intensity regimen has demonstrated a favorable safety profile, this trial remains open to enrollment for unrelated marrow donor transplants. Novel approaches aimed at improving engraftment will be needed before unrelated CBT can be widely adopted for transplanting patients with severe SCD.
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Affiliation(s)
- Naynesh R Kamani
- Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010, USA.
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20
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Allogeneic hematopoietic stem cell transplantation for sickle cell disease: the time is now. Blood 2011; 118:1197-207. [PMID: 21628400 DOI: 10.1182/blood-2011-01-332510] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Although sickle cell disease (SCD) has a variable clinical course, many patients develop end-organ complications that are associated with significant morbidity and early mortality. Myeloablative allogeneic HSCT (allo-HSCT) is curative but has been historically performed only in children younger than 16 years of age. Modest modifications in the conditioning regimen and supportive care have improved outcome such that the majority of children with a suitable HLA-matched sibling donor can expect a cure from this approach. However, adult patients have been excluded from myeloablative allo-HSCT because of anticipated excess toxicity resulting from accumulated disease burden. Efforts to use nonmyeloablative transplantation strategies in adults logically followed but were initially met with largely disappointing results. Recent results, however, indicate that nonmyeloablative allo-HSCT in adult patients with SCD allows for stable mixed hematopoietic chimerism with associated full-donor erythroid engraftment and normalization of blood counts, and persistence in some without continued immunosuppression suggests immunologic tolerance. The attainment of tolerance should allow extension of these potentially curative approaches to alternative donor sources. Efforts to build on these experiences should increase the use of allo-HSCT in patients with SCD while minimizing morbidity and mortality.
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21
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Abstract
Although hemagglutination serves the immunohematology reference laboratory well, when used alone, it has limited capability to resolve complex problems. This overview discusses how molecular approaches can be used in the immunohematology reference laboratory. In order to apply molecular approaches to immunohematology, knowledge of genes, DNA-based methods, and the molecular bases of blood groups are required. When applied correctly, DNA-based methods can predict blood groups to resolve ABO/Rh discrepancies, identify variant alleles, and screen donors for antigen-negative units. DNA-based testing in immunohematology is a valuable tool used to resolve blood group incompatibilities and to support patients in their transfusion needs.
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Affiliation(s)
- Marion E Reid
- New York Blood Center, 310 East 67th Street, New York, NY 10065, Telephone: 212-570-3294 / Fax: 212-737-4935,
| | - Gregory A Denomme
- Blood Center of Wisconsin, 638 18 Street, Milwaukee, WI, 53201-2178, Telephone: 414-937-6440 / Fax: 414-937-6404,
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22
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Quillen K, Medrano C, Adams S, Peterson B, Hackett J, Leitman SF, Klein HG, Stroncek DF. Screening plateletpheresis donors for HLA antibodies on two high-throughput platforms and correlation with recipient outcome. Transfusion 2010; 51:504-10. [PMID: 20849407 DOI: 10.1111/j.1537-2995.2010.02874.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND To determine the prevalence and impact of transfusing plasma containing white blood cell antibodies, we compared two high-throughput HLA antibody screening assays and prospectively examined the medical records of all platelet (PLT) recipients to detect subtle manifestations of transfusion-related acute lung injury and other transfusion reactions. STUDY DESIGN AND METHODS Serum samples from 136 plateletpheresis donors were tested for HLA Class I and II antibodies using microbead (LABScreen PRA, One Lambda) and microchip (Dynachip, Invitrogen) assays. Electronic medical records of all recipients were reviewed for vital signs and nursing documentation before and after transfusion. RESULTS In the microchip assay with a cutoff value of 0.25, 2.9% of samples were positive for Class I and 8.9% for Class II antibodies; with a cutoff value of 0.1, the results were 14.9 and 21.6%, respectively. In the microbead assay (normalized background ratio, 1.5), 15% were positive for Class I and 21% for Class II antibodies. The prevalence of HLA antibodies was 17% in donors without pregnancy or transfusion history and 47% in donors with such history. The PLTs were transfused in 265 episodes to 67 patients. There were no reported reactions; however, symptoms or vital sign changes were noted in seven transfusion episodes. The incidence of reactions was 2.7% (2/75) for antibody-positive units and 2.6% (5/190) for antibody-negative units. CONCLUSIONS Microbead and microchip assays yielded similar results. The prevalence of HLA antibodies was greater in donors with a history of pregnancy or transfusion, but no increase in the incidence of transfusion reactions was noted in recipients of components from donors with HLA antibodies.
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Affiliation(s)
- Karen Quillen
- Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland 02118, USA.
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