The effect of donor-specific anti-
human leukocyte antigen (HLA)
antibodies (DSAs) has been recognized as
a factor in graft failure (GF) in patients who underwent umbilical cord blood
transplantation (UBT), matched unrelated donor
transplantation (MUDT), or haploidentical
stem cell transplantation (haplo-SCT). Presently, we know little about the prevalence of and risk factors for having anti-HLA
antibodies among older transplant candidates. Therefore, we analyzed 273 older patients with
hematologic disease who were waiting for haplo-SCT. Among all patients, 73 (26.7%) patients had a positive panel-reactive antibody (PRA) result for class I, 38 (13.9%) for class II, and 32 (11.7%) for both. Multivariate analysis showed that females were at a higher risk for having a PRA result for class II (P = 0.001) and for having
antibodies against
HLA-C and
HLA-DQ. Prior pregnancy was a risk factor for having a PRA result for class I (P < 0.001) and for having
antibodies against
HLA-A,
HLA-B and
HLA-DQ.
Platelet transfusions were risk factors for the following: having a positive PRA result for class I (P = 0.014) and class II (P < 0.001); having
antibodies against
HLA-A,
HLA-B,
HLA-C,
HLA-DP,
HLA-DQ, and
HLA-DR; and having higher mean fluorescence intensity (MFI) of PRA for class I (P = 0.042). In addition, previous total transfusions were at high risk for having higher numbers of
antibodies to specific HLA loci (P = 0.005), and disease course (7.5 months or more) (P = 0.020) were related to higher MFI of PRAs for class I. Our findings indicated that female sex, prior pregnancy,
platelet transfusions and disease courses are independent risk factors for older patients with
hematologic disease for having anti-HLA
antibodies, which could guide anti-HLA antibody monitoring and be helpful for
donor selection.