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Successful desensitization of high level donor-specific anti-HLA antibody in patients with hematological diseases receiving haploidentical allografts

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Abstract

Donor-specific anti-human leukocyte antigen (HLA) antibody (DSA) is associated with a higher incidence of graft failure and mortality in HLA-mismatched allograft settings. However, the optimal protocol of desensitization for patients with positive DSA remains uncertain. We investigated the effectiveness of a desensitization protocol, including rituximab, high-dose intravenous immunoglobulin (IVIG), and a single session of plasma exchange (PE), for haploidentical allograft recipients with a high mean fluorescence intensity (MFI) level of DSA (≥ 5,000). Eleven patients with hematological disease who had positive DSA (median, 11,676, range 5387–20,435) were desensitized by the protocol. All of the patients achieved hematopoietic recovery. The median times for neutrophil and platelet engraftment were 13 (range, 11–26) days and 19 (range, 11–90) days, respectively. Grade II–IV acute graft-versus-host disease (GVHD) was seen in one patient and was controlled completely. Chronic cutaneous GVHD was seen in eight patients. Nine patients are alive with good performance so far. One patient suffered extramedullary relapse, and one patient died of transplantation-associated thrombotic microangiopathy. The 1-year probability of overall survival was 81.8%. These results suggest that successful desensitization could be obtained by a combination of rituximab, high-dose IVIG, and PE for haploidentical allograft recipients with high MFI levels of DSA.

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Acknowledgements

The authors are grateful for Yingjun Chang for his assistance in the design of desensitization protocol and editing this manuscript.

Funding

This work was supported by the Capital Health Development Foundation of China (2014–2-5122).

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Author notes

  1. Xiaoli Zheng and Hongmin Yan contributed equally to this work.

Authors and Affiliations

  1. Department of Hematology, Air Force Medical Center, PLA, Beijing, China

    Xiaoli Zheng, Hongmin Yan, Dongmei Han, Li Ding, Ling Zhu, Jing Liu, Mei Xue, Sheng Li & Hengxiang Wang

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  1. Xiaoli Zheng
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  2. Hongmin Yan
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  3. Dongmei Han
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  4. Li Ding
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  5. Ling Zhu
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  6. Jing Liu
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  7. Mei Xue
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  8. Sheng Li
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  9. Hengxiang Wang
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Contributions

WHX designed the research. ZXL and YHM performed the experiments and collected and analyzed the data. HDM, DL, ZL, LJ, XM, and LS provided technical and clinical expertise. ZXL and YHM wrote the manuscript. WHX edited the manuscript. All authors have read and approved the final manuscript.

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Correspondence to Hengxiang Wang.

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The authors declare no competing interests.

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Zheng, X., Yan, H., Han, D. et al. Successful desensitization of high level donor-specific anti-HLA antibody in patients with hematological diseases receiving haploidentical allografts. Ann Hematol 101, 1777–1783 (2022). https://doi.org/10.1007/s00277-022-04844-5

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  • DOI: https://doi.org/10.1007/s00277-022-04844-5

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