预形成抗hla DQA1/DQB1 DSA可能是单倍体干细胞移植失败的原因。

IF 2.1 4区 医学 Q2 HEMATOLOGY
Expert Review of Hematology Pub Date : 2025-08-01 Epub Date: 2025-06-22 DOI:10.1080/17474086.2025.2522307
HeHua Wang, Jing Cheng, Fan Zhang, JunXun Li
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引用次数: 0

摘要

研究设计和方法:我们报道了首例PGF与单独针对HLA-DQ的预形成高水平DSA相关的病例。这位39岁的病人被诊断为急性髓性白血病。她接受了儿子的单倍体移植,患上了PGF。脱敏后,她对儿子的HLA-DQA1和HLA-DQB1分子持续存在高水平的dsa。没有其他的捐赠者。结果:为了避免第二次移植失败,我们采用了两种不相关脐带血(CB)和g - csf激发的骨髓(BM)和外周血干细胞(PBSCs)结合的方法,这些干细胞来自她儿子的移植。BM短串联重复序列(STRs)分析显示,一个单位的CB完全移植,而她儿子的移植物仍未能移植。结论:我们得出结论,在我们的病例中,高水平的抗hla DQA1/DQB1 DSA可能与PGF有关。除针对HLA-A、-B和-DR的dsa外,还应关注针对HLA-DQ分子的dsa。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Preformed anti-HLA DQA1/DQB1 DSA possibly responsible for graft failure in haploidentical stem cell transplantation.

Background: Primary graft failure (PGF) is a life-threatening complication of allogeneic hematopoietic stem cell transplants (HSCT) and is associated with poor outcomes. Most clinical studies have focused on donor-specific anti-HLA antibodies (DSAs) against HLA-A, -B, and -DR molecules.

Research design and methods: We present the first reported case of PGF associated with a preformed high-level DSA against HLA-DQ alone. The 39-year-old patient was diagnosed with acute myeloid leukemia. She received a haploidentical graft from her son and suffered PGF. She had persistently high levels of DSAs against her son's HLA-DQA1 and HLA-DQB1 molecules after desensitization. No alternative donor was available.

Results: To circumvent the second graft failure, we adopted an approach of combining two units of unrelated cord blood (CB) and G-CSF-primed bone marrow (BM) and peripheral blood stem cells (PBSCs) from her son's transplants. The BM short tandem repeats (STRs) assay showed that one unit of the CB was fully engrafted, and the grafts from her son still failed to engraft.

Conclusions: We conclude that high levels of anti-HLA DQA1/DQB1 DSA could be associated with PGF in our case. Besides DSAs against HLA-A, -B, and -DR, attention should also be paid to DSAs against the HLA-DQ molecule.

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来源期刊
CiteScore
4.70
自引率
3.60%
发文量
98
审稿时长
6-12 weeks
期刊介绍: Advanced molecular research techniques have transformed hematology in recent years. With improved understanding of hematologic diseases, we now have the opportunity to research and evaluate new biological therapies, new drugs and drug combinations, new treatment schedules and novel approaches including stem cell transplantation. We can also expect proteomics, molecular genetics and biomarker research to facilitate new diagnostic approaches and the identification of appropriate therapies. Further advances in our knowledge regarding the formation and function of blood cells and blood-forming tissues should ensue, and it will be a major challenge for hematologists to adopt these new paradigms and develop integrated strategies to define the best possible patient care. Expert Review of Hematology (1747-4086) puts these advances in context and explores how they will translate directly into clinical practice.
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