BACKGROUND: Evaluation of patient sera for complement-fixing anti-donor antibodies (serum crossmatch [XM]) before allogeneic blood stem cell transplantation (BSCT) is routine in most centers. However, in contrast to kidney transplantation, the predictive value of a positive XM for outcome of BSCT is still unclear, and a positive XM is presently not regarded as an absolute contraindication to proceed to transplant. METHODS: To clarify the role of a positive XM as predictor for overall survival (OS) and graft failure (GF) after BSCT, a retrospective, single-center, matched-pair analysis was performed. Enrolled were all XM-positive BSCT performed at our institution from 1985 to 2000 (n=30). Controls (n=30) were matched for disease, disease stage, patient age, period of transplant, conditioning regimen, protocol for prevention of graft-versus-host disease, and type of donor (related vs. unrelated, HLA-identical vs. HLA-mismatched). RESULTS: Multivariate statistical analysis of all enrolled 60 transplants revealed GF as the all-dominating, independent risk factors for low OS (relative risk [RR]: 59.5, P<0.0001). Univariate (Kaplan-Meier) analysis could attribute inferior OS and high incidence of GF to the subgroup of HLA-mismatched, XM-positive transplants (P=0.01). CONCLUSIONS: A XM should always be performed in patients awaiting a BSCT from HLA-mismatched donors, because a positive XM is a predictor for inferior OS due to GF in BSCT.
BACKGROUND: Evaluation of patient sera for complement-fixing anti-donor antibodies (serum crossmatch [XM]) before allogeneic blood stem cell transplantation (BSCT) is routine in most centers. However, in contrast to kidney transplantation, the predictive value of a positive XM for outcome of BSCT is still unclear, and a positive XM is presently not regarded as an absolute contraindication to proceed to transplant. METHODS: To clarify the role of a positive XM as predictor for overall survival (OS) and graft failure (GF) after BSCT, a retrospective, single-center, matched-pair analysis was performed. Enrolled were all XM-positive BSCT performed at our institution from 1985 to 2000 (n=30). Controls (n=30) were matched for disease, disease stage, patient age, period of transplant, conditioning regimen, protocol for prevention of graft-versus-host disease, and type of donor (related vs. unrelated, HLA-identical vs. HLA-mismatched). RESULTS: Multivariate statistical analysis of all enrolled 60 transplants revealed GF as the all-dominating, independent risk factors for low OS (relative risk [RR]: 59.5, P<0.0001). Univariate (Kaplan-Meier) analysis could attribute inferior OS and high incidence of GF to the subgroup of HLA-mismatched, XM-positive transplants (P=0.01). CONCLUSIONS: A XM should always be performed in patients awaiting a BSCT from HLA-mismatched donors, because a positive XM is a predictor for inferior OS due to GF in BSCT.
Authors: Stephen R Spellman; Mary Eapen; Brent R Logan; Carlheinz Mueller; Pablo Rubinstein; Michelle I Setterholm; Ann E Woolfrey; Mary M Horowitz; Dennis L Confer; Carolyn K Hurley Journal: Blood Date: 2012-05-17 Impact factor: 22.113
Authors: R Hanajiri; M Murata; K Sugimoto; M Murase; R Sakemura; T Goto; K Watanabe; N Imahashi; S Terakura; H Ohashi; Y Akatsuka; S Kurahashi; K Miyamura; H Kiyoi; T Nishida; T Naoe Journal: Bone Marrow Transplant Date: 2015-06-01 Impact factor: 5.483
Authors: Carolyn Katovich Hurley; Ann Woolfrey; Tao Wang; Michael Haagenson; John Umejiego; Mahmoud Aljurf; Medhat Askar; Minoo Battiwalla; Jason Dehn; John Horan; Machteld Oudshoorn; Joseph Pidala; Wael Saber; Victoria Turner; Stephanie J Lee; Stephen R Spellman Journal: Blood Date: 2013-05-01 Impact factor: 22.113
Authors: M Koyama; D Hashimoto; K Nagafuji; T Eto; Y Ohno; K Aoyama; H Iwasaki; T Miyamoto; G R Hill; K Akashi; T Teshima Journal: Bone Marrow Transplant Date: 2013-09-09 Impact factor: 5.483
Authors: Stephen Spellman; Robert Bray; Sandra Rosen-Bronson; Michael Haagenson; John Klein; Susan Flesch; Cynthia Vierra-Green; Claudio Anasetti Journal: Blood Date: 2010-01-20 Impact factor: 22.113
Authors: Parastoo B Dahi; Jonathan Barone; Sean M Devlin; Courtney Byam; Marissa Lubin; Doris M Ponce; Sergio Giralt; Nancy A Kernan; Andromachi Scaradavou; Susan H Hsu; Juliet N Barker Journal: Biol Blood Marrow Transplant Date: 2014-01-23 Impact factor: 5.742