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Acute mixed-lineage leukemia treated with desensitization therapy prior to HLA–haploidentical transplantation with high donor-specific antibodies

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Abstract

A 43-year-old woman was referred to our department for hematopoietic stem cell transplantation for acute myeloid leukemia, as she failed to achieve remission following induction therapy. Umbilical cord blood transplantation was initially planned; however, multiple anti-human leukocyte antigen (HLA) antibodies with a mean fluorescence intensity of over 10,000 were detected, and optimal umbilical cord blood could not be obtained. The plan was then switched to peripheral blood stem cell transplantation (PBSCT) from the patient’s son, who had a 5/8 HLA haploidentical match. However, the patient had donor-specific antibodies against the donor’s HLA-B 0702 and HLA-C 0702. To address this issue, after rituximab therapy, the patient was given platelet transfusions from B0702- and C0702-positive donors on day − 1 and day 0, and immunoglobulin on day 0, followed by PBSCT. Donor-specific antibodies decreased by over 90%, and engraftment was confirmed on day 13. Since then, the patient has remained relapse-free and healthy. This case suggests that appropriate management of donor-specific antibodies can enable safe transplantation, even in donors who test positive for these antibodies.

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All data generated in this study are included in this manuscript. Further inquiries can be directed to the corresponding author.

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Authors and Affiliations

  1. Department of Hematology and Oncology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan

    Kengo Katsuki, Takayoshi Tachibana, Akihiko Izumi & Masatsugu Tanaka

  2. Department of Laboratory, Kanagawa Cancer Center, Yokohama, Japan

    Kumryo Kim

  3. Department of Hematology, Fujisawa City Hospital, Fujisawa, Japan

    Taisei Suzuki

  4. Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Yokohama, Japan

    Hideaki Nakajima

Authors
  1. Kengo Katsuki
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  2. Takayoshi Tachibana
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  3. Akihiko Izumi
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  4. Kumryo Kim
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  5. Taisei Suzuki
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  6. Masatsugu Tanaka
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  7. Hideaki Nakajima
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Corresponding author

Correspondence to Takayoshi Tachibana.

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Conflict of interest

HN reports honoraria from Novartis and Daiichi-Sankyo, outside the submitted work. TT reports honoraria from Pfizer, Otsuka, MSD, Abbvie, Chugai, Asahi Kasei-Pharma, and Astellas, outside the submitted work. HN reports grant/research support from Daiichi-Sankyo, Cellgene, Chugai, Nihon-Shinyaku, outside the submitted work. HN reports scholarship from Astellas, Asahi Kasei-Pharma, Chugai, Takeda, Pfizer, and Eisai, outside the submitted work.

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New findings: In hematopoietic stem cell transplantation, when the recipient has anti-HLA antibodies, especially donor-specific antibodies (DSA), desensitization therapy is required to reduce their titers, but this strategy has not yet been established. We have experience with a recipient with high DSA titers who was successfully treated with rituximab, immunoglobulin, and DSA-positive platelets to reduce titers and achieve successful engraftment. This suggests a strategy to effectively reduce DSA titers.

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Katsuki, K., Tachibana, T., Izumi, A. et al. Acute mixed-lineage leukemia treated with desensitization therapy prior to HLA–haploidentical transplantation with high donor-specific antibodies. Int J Hematol (2024). https://doi.org/10.1007/s12185-024-03775-3

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  • DOI: https://doi.org/10.1007/s12185-024-03775-3

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