National Institutes of Health Bethesda, Maryland, United States
Background/Case Studies: There is limited research on antibodies against human neutrophil antigen (HNA) in patients undergoing hematopoietic progenitor cell (HPC) transplantation and their effect on primary and secondary graft failure, graft function, and donor chimerism.
Study
Design/Methods: A retrospective review of 21 patients with anti-HNA tests and HPC transplants at the NIH Clinical Center was conducted, along with 42 control cohort patients from six research protocols. The data were collected with approval from the Institutional Review Board (IRB) number #000568 at the NIH.
Results/Findings: The cumulative incidence of time to neutrophil engraftment was significantly impacted by the patient's anti-HNA status (p = 0.04), with the patients with positive anti-HNA experiencing slower engraftment rates. Secondary graft failure occurred in 9.25% (95% confidence interval [CI]: 3.76–22.06) of the control cohort, while 55.5% (95% CI: 26.66–81.12) of the positive anti-HNA cohort experienced secondary graft failure (p = 0.005). Furthermore, patients with positive anti-HNA had a lower proportion (p = 0.008 for full and p = 0.002 for partial chimerism) and cumulative incidence (p = 0.04 for full and p = 0.04 for partial chimerism) of achieving donor chimerism compared to the control cohort. Conclusions: This study identified a potential association between anti-HNA antibodies and HPC transplantation, which had not been previously reported. Specifically, patients who tested positive for anti-HNA had a lower proportion and cumulative incidence of achieving donor chimerism, a slower rate of neutrophil engraftment, and an increased risk of secondary failure.
Importance of research: This study reveals a potential link between anti-HNA and HPC transplantation outcomes, identifying the impact of positive anti-HNA status on neutrophil engraftment, secondary graft failure and donor chimerism, contributing novel insights to the transplantation field.
