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Successful engraftment in recipients of haploidentical stem cells with donor-specific antibodies: role of flow cytometric cross-match

Bone Marrow Transplantation volume 54, pages 907–910 (2019)Cite this article

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The use of haploidentical family donors is the most rapidly expanding donor pool [1]. Human leukocyte antigen (HLA) antibodies play a significant role in the success, or failure, of a mismatched stem cell transplant [2]. The presence of preformed donor-specific antibodies (DSAs) in recipients at the time of transplant is associated with an increase in graft failure and is a relative contraindication for haploidentical stem cell transplantation. Studies suggest that a higher mean fluorescent intensity (MFI), as a measure of the strength of DSA, is associated with a higher risk of graft failure, but a cut-off value, above which the DSA is more likely to cause graft failure or not, has yet to be universally agreed on, although a recent guideline approaches this issue [3]. This report includes a series of patients who have undergone haploidentical transplants and explores the current literature surrounding the use of DSA detection and cross-matching in haematopoietic cell transplantation (HCT).

Patient sera were screened for the presence of potential DSA using Labscreen single antigen beads (OneLambda, Canoga Park, CA) on the Luminex platform. This method detects antibody bound to single specificity HLA antigens immobilised on the surface of polystyrene beads. Bound antibody is detected through the fluorescence of a secondary phycoerythrin (PE)-labelled anti-human immunoglobulin G (IgG) monoclonal antibody (mAb) on the Luminex platform. The fluorescence intensity is reported as a semi-quantitative value, the MFI. MFI values of >1000 are considered positive for the presence of antibody to the given HLA antigen.

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Authors and Affiliations

  1. Croydon University Hospital, London, UK

    Marianne Gallanagh

  2. Clinical Transplantation Laboratory, Viapath, Guy’s Hospital, London, UK

    Olivia Shaw

  3. Royal Hallamshire Hospital, Sheffield, UK

    Harpreet Kaur

  4. King’s College Hospital, London, UK

    Kavita Raj

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  1. Marianne Gallanagh
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  2. Olivia Shaw
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  4. Kavita Raj
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Correspondence to Marianne Gallanagh.

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Gallanagh, M., Shaw, O., Kaur, H. et al. Successful engraftment in recipients of haploidentical stem cells with donor-specific antibodies: role of flow cytometric cross-match. Bone Marrow Transplant 54, 907–910 (2019). https://doi.org/10.1038/s41409-018-0384-1

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