Anti-HLA Antibodies: Assessment and Mitigating Strategies

Chapter
Part of the Advances and Controversies in Hematopoietic Transplantation and Cell Therapy book series (ACHTCT)

Abstract

Transplantation from one human leukocyte antigen (HLA) haplotype-matched first-degree relatives (haplo-HCT) is the most accessible graft source and has been increasingly used as an alternative option for patients without a suitable HLA-matched donor. However, the intense bidirectional alloreactive reactions related to the major HLA mismatch between the recipient and haploidentical donor can result in higher incidence of graft-versus-host disease (GvHD) and graft failure (GF). The increased risk of graft failure following haplo-HCT is due, in part, to an enhanced susceptibility of the graft to chemoresistant host natural killer (NK) cell and T-lymphocyte-mediated rejection against mismatched donor cells (cellular rejection). In addition, antibody-mediated rejection (humoral rejection) occurring either by antibody-dependent cell-mediated cytotoxicity or complement-mediated cytotoxicity also has been described. Over the recent years, several methods have been developed to more precisely detect and characterize serum anti-HLA antibodies in allo-HCT recipients, and also the clear association between the presence of these donor-specific anti-HLA antibodies (DSAs) and the development of primary GF has been established. In this chapter, we will focus on the DSA testing and its impact on primary graft failure in haplo-HCT as well as the progress made in the treatment of patients with DSA in order to improve engraftment rate and transplant outcomes.

Keywords

Haploidentical transplant Mismatch transplant Donor-specific antibodies Graft rejection Anti-HLA antibodies 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Stem Cell Transplant and Cellular Therapy, The University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Division of Hematology, Department of Internal Medicine, Faculty of MedicineThammasat UniversityPathumthaniThailand
  3. 3.Department of Laboratory MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA

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