Role of HLA Antibodies in Allogenic Stem Cell Transplantation-Pre Transplant Assessment and Post Transplant Monitoring

Dr Saurabh Moond; Dr Kavita Sahai; Dr GPS Gahlot; Dr S Agarwal; Dr Pankaj Pandey; Dr Chetan Agarwal; Dr Murari Lal Dhanetwal

Volume : VIII, Issue : XII, December - 2019

Role of HLA Antibodies in Allogenic Stem Cell Transplantation-Pre Transplant Assessment and Post Transplant Monitoring

Dr Saurabh Moond, Dr Kavita Sahai, Dr Gps Gahlot, Dr S Agarwal, Dr Pankaj Pandey, Dr Chetan Agarwal, Dr Murari Lal Dhanetwal

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 & post–transplant 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.