Transplant Center, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Tianjin, China.
J Clin Lab Anal. 2020 Jul;34(7):e23261. doi: 10.1002/jcla.23261. Epub 2020 Feb 28.
Donor-specific anti-human leukocyte antigen (HLA) antibodies (DSAs) in recipients is a risk factor for donor stem cell graft failure in haploidentical hematopoietic stem cell transplantation (haplo-HSCT), and the treatment to reduce the levels of DSAs is not unanimous. This study was to analysis the role of DSAs for stem cell engraftment and to discuss the effective treatment to reduce DSAs in haplo-HSCT.
We retrospectively evaluated the levels of DSAs and the effect of the combination treatment of rituximab and donor platelets (PLTs) for donor stem cell engraftment in haplo-HSCT patients from June 2016 to March 2018 at our center.
Nine patients (11.5%) out of the total 78 patients were DSAs-positive and multivariate analysis revealed DSAs was the only factor that affected engraftment. Seven out of the 9 DSAs (+) patients received therapy: Four had antibodies against donor HLA class I (HLA-I) antigens and were administered two therapeutic amounts of donor apheresis platelets (platelet count approximately 3-5 × 10 ) before donor stem cell infusion and the other three patients received a combination therapy of donor apheresis platelets and rituximab due to the antibodies against both donor HLA-I antigens and HLA class II (HLA-II) antigens. All the seven patients achieved donor stem cell engraftment successfully, and the DSAs levels decreased rapidly after transplantation.
DSAs is an important factor affecting engraftment in haplo-HSCT. Donor platelet transfusion is one simple and effective treatment for HLA-I DSAs, and a combination therapy should be administered if patients have both HLA-I and HLA-II antibodies.
受者体内的供体特异性抗人类白细胞抗原（HLA）抗体（DSAs）是单倍体造血干细胞移植（haplo-HSCT）中供体干细胞移植物失败的危险因素，而降低 DSAs 水平的治疗方法并不统一。本研究旨在分析 DSAs 对干细胞植入的作用，并探讨降低 haplo-HSCT 中 DSAs 的有效治疗方法。
我们回顾性评估了 2016 年 6 月至 2018 年 3 月在我中心进行的 haplo-HSCT 患者中 DSAs 水平及其对供体干细胞植入的影响，并对供体血小板（PLTs）与利妥昔单抗联合治疗的效果进行了评估。
在总共 78 例患者中，有 9 例（11.5%）为 DSAs 阳性，多变量分析显示 DSAs 是影响植入的唯一因素。9 例 DSAs（+）患者中有 7 例接受了治疗：4 例患者针对供体 HLA-I 抗原的抗体，在供体干细胞输注前接受了两次供体单采血小板输注（血小板计数约为 3-5×10 ），另外 3 例患者由于针对供体 HLA-I 抗原和 HLA-II 抗原的抗体，接受了供体单采血小板和利妥昔单抗的联合治疗。所有 7 例患者均成功获得供体干细胞植入，移植后 DSAs 水平迅速下降。
DSAs 是影响 haplo-HSCT 植入的重要因素。供体血小板输注是治疗 HLA-I DSAs 的一种简单有效的方法，如果患者同时存在 HLA-I 和 HLA-II 抗体，则应采用联合治疗。
