Lesan Vadim, Melivadze Ketevani, Hein Johannes, Ahlgrimm Manfred, Schunk Stefan, Bewarder Moritz, Christofyllakis Konstantinos, Bittenbring Joerg Thomas, Thurner Lorenz
Department of Hematology and Oncology Internal Medicine I Saarland University Medical School Homburg Germany.
Department of Nephrology Saarland University Medical School Homburg Germany.
EJHaem. 2024 Jun 19;5(4):863-866. doi: 10.1002/jha2.936. eCollection 2024 Aug.
Donor-specific anti-human leukocyte antigen (HLA) antibodies represent a main cause of primary graft failure specifically in the setting of haploidentical stem cell transplantation. Newer therapy strategies including daratumumab could overcome some of these limitations. We describe the case of a patient with refractory acute myeloid leukemia. A haploidentical allogeneic stem cell transplantation was therefore initiated. HLA-antibodies testing revealed a high titer of donor-specific antibodies. First desensitization therapy failed, resulting in primary graft failure. A second desensitization regimen including plasmapheresis, intravenous gammaglobulins, and daratumumab resulted in good engraftment. Daratumumab is a promising and effective desensitization option in high-risk allo-sensitized patients undergoing haploidentical stem cell transplantation.
供者特异性抗人白细胞抗原（HLA）抗体是原发性移植物功能衰竭的主要原因，特别是在单倍体相合干细胞移植的情况下。包括达雷妥尤单抗在内的新型治疗策略可以克服其中一些局限性。我们描述了一名难治性急性髓系白血病患者的病例。因此启动了单倍体相合异基因干细胞移植。HLA抗体检测显示存在高滴度的供者特异性抗体。首次脱敏治疗失败，导致原发性移植物功能衰竭。包括血浆置换、静脉注射免疫球蛋白和达雷妥尤单抗在内的第二次脱敏方案导致了良好的植入。达雷妥尤单抗对于接受单倍体相合干细胞移植的高风险同种异体致敏患者是一种有前景且有效的脱敏选择。
