Pretransplant desensitization of donor-specific anti-HLA antibodies with plasmapheresis and immunoglobulin produces equivalent outcomes to patients with no donor specific antibodies in haploidentical hematopoietic cell transplant

被引：2

作者：

Cochran, Hunter Cassidy ^{[1
]}

Slade, Michael Joseph ^{[2
]}

Liu, Chang ^{[3
]}

Gao, Feng ^{[4
]}

Godbole, Sonia ^{[5
]}

Pruitt, Aaron ^{[5
]}

De Togni, Elisa ^{[5
]}

Grossman, Brenda ^{[3
]}

Abboud, Ramzi ^{[1
]}

机构：

[1] Washington Univ, Dept Med, Div Oncol, St Louis, MO USA

[2] Washington Univ, Sch Med, Div Oncol, Bone Marrow Transplantat & Leukemia Sect, St Louis, MO USA

[3] Washington Univ, Sch Med, Pathol & Immunol, St Louis, MO USA

[4] Washington Univ, Sch Med, Dept Surg, Sect Oncol Biostat,Div Publ Hlth Sci, St Louis, MO USA

[5] Washington Univ, Sch Med, Internal Med, St Louis, MO USA

来源：

LEUKEMIA & LYMPHOMA | 2024年 / 65卷 / 12期

基金：

美国国家卫生研究院;

关键词：

Haplo; DSA; transplant; desensitization; allogeneic; GRAFT FAILURE; RISK; INDEX; BLOOD;

D O I：

10.1080/10428194.2024.2376172

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Haploidentical hematopoietic cell transplants (haplo-HCT) with donor-specific anti-HLA antibodies (DSAs) are associated with high rates of primary graft failure and poor overall survival (OS). Limited data exists regarding the effect of desensitization. Our institution began routine desensitization for patients with DSAs in 2014. Adult patients undergoing haplo-HCT at Washington University from 2009-2021 were identified and divided into three cohorts: no DSA, untreated DSA (2009-2014) or treated DSA (2014-2021). Desensitization therapy using plasmapheresis and IVIg was performed. Retrospectively, 304 patients were identified. 14 of 30 patients with DSAs underwent desensitization. By day +2, 57% of patients cleared all DSAs. After multivariable analysis, OS was similar between treated DSA and no DSA (HR: 0.69, p = 0.37). Untreated DSA had significantly lower OS compared to no DSA group (HR 1.80, p = 0.046). Desensitization with a backbone of plasmapheresis and IVIg before haplo-HCT may produce similar outcomes to patients without DSAs.

引用

页码：1811 / 1819

页数：9

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