Epitope-based matching for HLA-alloimmunized platelet refractoriness in patients with hematologic diseases
Journal
Transfusion
Journal Volume
50
Journal Issue
11
Pages
2318-2327
Date Issued
2010
Author(s)
Abstract
Background: For HLA-alloimmunized patients, platelet (PLT) concentrations are provided either at matched HLA-A and HLA-B loci or by serologic cross-reactivity groups (CREG) matching strategy. However, this method has some limitations. STUDY DESIGN AND METHODS: In this study, the epitope-based matching (EBM) method was evaluated for selecting proper HLA-typed PLTs for patients with PLT transfusion refractoriness. Bead-based single-antigen HLA antibody detection method and HLAMatchmaker software were used to define the epitopes recognized by HLA-specific antibodies and to select compatible PLTs for nine patients with alloimmunized refractoriness. Corrected count increments (CCIs) were prospectively determined to compare successful transfusion rates among different matching methods in 142 PLT transfusions. In addition, HLA antibodies were serially detected to see whether any emerging antibodies appeared after receiving the EBM-matched PLTs. RESULTS: The transfusion success rates evaluated with 1-hour CCIs for perfect matching or lacking any mismatching at HLA-A and -B locus (A/BU)-matched, CREG-matched, and EBM-matched PLTs were 85.2, 63.2, and 83.7%, respectively. Compared to CREG-matched PLTs, EBM-matched PLTs showed better transfusion results (p = 0.035). In the follow-up study (7 months; range, 3-13 months), no emerging HLA-specific antibodies were detected after receiving EBM-matched PLTs. CONCLUSIONS: EBM performed on the basis of bead-based single-antigen HLA antibody detection coupled with the HLAMatchmaker program is recommended in choosing proper PLTs for refractory patients when A/BU-matched PLTs were not available. ? 2010 American Association of Blood Banks.
SDGs
Other Subjects
alloantibody; epitope; HLA antibody; acute lymphoblastic leukemia; adult; aged; alloimmunization; antibody screening; aplastic anemia; article; bone marrow transplantation; chronic myeloid leukemia; controlled study; female; hematologic disease; HLA matching; human; lymphatic leukemia; major clinical study; male; myelodysplastic syndrome; stem cell transplantation; thrombocyte transfusion; treatment outcome; Adult; Aged; Anemia, Aplastic; Antigens, Human Platelet; Blood Platelets; Cross Reactions; Epitope Mapping; Epitopes; Female; Hematologic Diseases; Histocompatibility Testing; HLA Antigens; Humans; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Leukemia, Myeloid, Acute; Male; Middle Aged; Myelodysplastic Syndromes; Platelet Transfusion; Prospective Studies; Software
Type
journal article