Neutrophil antigen antibodies affect engraftment and secondary graft failure in hematopoietic progenitor cell transplantation

Background: Research is limited on the role of antibodies against human neutrophil antigen (HNA) in hematopoietic progenitor cell (HPC) transplantation outcomes. Study Design and Methods: A retrospective review was conducted on medical records of patients at the NIH Clinical Center enrolled in six research protocols. This case–control study included 21 patients tested for HNA antibodies from January 2010 to March 2022 who underwent HPC transplantation. In addition, 42 patients following the same research protocols were randomly selected as a control group. Results: The cumulative incidence of time to neutrophil engraftment was significantly impacted by the patients' anti-HNA status (p =.042), with the patients with anti-HNA experiencing delayed engraftment. Secondary graft failure occurred in 4 out of 42 patients (9.52%; 95% confidence interval [CI]: 3.7–22.1) of the control group, while 5 out of 9 patients (55.5%; 95% CI: 26.7–81.1) with anti-HNA experienced secondary graft failure (p =.005). Furthermore, patients with anti-HNA had a lower proportion (p =.008 for full and p =.002 for partial chimerism) and cumulative incidence (p =.016 for full and p =.010 for partial chimerism) of achieving donor chimerism compared to the control group. Discussion: The study reveals a potential link between anti-HNA and HPC transplantation outcomes not previously reported. Patients with anti-HNA had a lower proportion and cumulative incidence of achieving donor chimerism. Additionally, anti-HNA status affected the time for neutrophil engraftment, with a slower rate of neutrophil engraftment and increased risk of secondary failure in patients with anti-HNA.