[Impact of non-donor specific HLA antibodies on outcomes of allogeneic hematopoietic stem cell transplantation].

Abstract

We retrospectively analyzed the data of patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) and completed anti-HLA antibody screening at our center between January 2016 to July 2025 to examine the impact of non-donor specific HLA antibodies (NDSA) on the clinical outcomes in this patient population and to analyze the potential efficacy of using desensitization therapies. Among the 618 patients screened patients, 379 underwent allo-HSCT. Fifty-five patients were NDSA-positive. Based on the screening results, NDSA-positive patients were divided into the following groups according to the mean fluorescence intensity (MFI) : 1 000≤MFI<10,000 and MFI≥10,000 groups. Compared with the antibody-negative group, the NDSA-positive patients were older, more likely to be female, and had a higher rate of prior pregnancy (P<0.05). In the fully matched transplants without desensitization, the 3-year overall survival (OS) was significantly lower in the NDSA-positive group (P=0.043). Stratified analysis showed that NDSA MFI of ≥10,000 was as an independent risk factor for inferior 3-year OS (HR=4.364, 95% CI: 1.041-18.291, P<0.05) and event-free survival (EFS) (HR=3.453, 95% CI: 1.035-11.518, P<0.05). In the propensity score-matched NDSA-positive cohort, the desensitization group showed numerically higher 3-year OS[100% vs (66.7±15.7) %, P=0.123] and EFS[ (83.3±15.2) % vs (53.3±17.3) %, P=0.253] than the untreated group. Our study findings suggest that NDSA MFI of ≥10,000 may be associated with poorer long-term survival in patients receiving fully matched allo-HSCT. Desensitization therapy may improve the long-term outcomes of these patients.