Platelet transfusions in haploidentical haematopoietic stem cell allograft candidates: Protecting HLA‐A and HLA‐B antigens through eplet analysis

Author:

Durand Gatien12,Desoutter Judith12,Lorriaux Corinne3,Poumaredes Géraldine4,Joris Magalie5,Charbonnier Amandine5,Lebon Delphine25,Paubelle Etienne25,Garcon Loïc12,Guillaume Nicolas12ORCID

Affiliation:

1. Department of Haematology and Histocompatibility Amiens University Hospital Amiens France

2. EA HEMATIM 4666 Jules Verne University of Picardie Amiens France

3. Department of Blood Transfusions Amiens University Hospital Amiens France

4. Department of Biology Etablissement Français du Sang (EFS) Hauts de France Amiens France

5. Department of Clinical Haematology and Cellular Therapy Amiens University Hospital Amiens France

Abstract

In patients awaiting an allogeneic haematopoietic stem cell transplantation, platelet transfusion is a risk factor for anti‐HLA class I immunization because the resulting donor‐specific antibodies complicate the allograft process. The objective of the present study was to determine the feasibility of a novel eplet‐based strategy for identifying HLA class I mismatches between potential donors and the recipient when pre‐allograft platelet transfusions were required. We included 114 recipient/haploidentical relative pairs. For each pair, we entered HLA‐class I typing data into the HLA Eplet Mismatch calculator, defined the list of mismatched eplets (for the recipient versus donor direction) and thus identified the shared HLAs to be avoided. Using this list of HLAs, we defined the theoretical availability of platelet components (PCs) by calculating the virtual panel‐reactive antibody (vPRA). We also determined the number of PCs actually available in France by querying the regional transfusion centre's database. The mean ± standard deviation number of highly/moderately exposed eplets to be avoided in platelet transfusions was 5.8 ± 3.3, which led to the prohibition of 38.5 ± 2 HLAs‐A and ‐B. Taking into account the mismatched antigens and the eplet load, the mean ± standard deviation theoretical availability of PCs (according to the vPRA) was respectively 34.49% ± 1.95% for HLA‐A and 80% ± 2.3% for HLA‐B. A vPRA value below 94.9% for highly or moderately exposed eplets would predict that 10 PCs were actually available nationally. Although epitope protection of HLA molecules is feasible, it significantly restricts the choice of PCs.

Publisher

Wiley

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