Li Xiaoping, Li Yu, Zhang Dingsong, Hu Xiaozhuang, Liu Lin, Yuan Zhongtao, Li Shiqi, Dong Yancheng, Chen Yingnian, Wang Sanbin
Department of Hematology, 920th Hospital of Joint Logistics Support Force, Kunming, China.
Shanghai Tissuebank Biotechnology Co., Ltd, Shanghai, China.
Cell Transplant. 2025 Jan-Dec;34:9636897241303292. doi: 10.1177/09636897241303292.
Donor-specific antibodies (DSAs) are essential causes of graft rejection in haploidentical hematopoietic stem cell transplantation (haplo-HSCT). DSAs are unavoidable for some patients who have no alternative donor. Effective interventions to reduce DSAs are still needed, and the cost of the current therapies is relatively high. In this study, we retrospectively analyzed the data of 11 DSA-positive patients who received haplo-HSCT at our center and evaluated the therapeutic efficacy of the combination of intravenous immunoglobulin (IVIG), dexamethasone and high dose of transfused mononuclear cells (MNCs) for DSA desensitization. The kinetics of DSAs at different times and the engraftment and transplantation outcomes were also observed. We found that all patients had successful donor-cell engraftment and that no patient developed poor graft function. The median engraftment times of neutrophils and platelets were 14 days (range, 11-24 days) and 13 days (range, 11-123 days), respectively. The DSA levels of all patients became negative or dropped under 2000 within 22 days after HSCT. A total of 36.4% of patients developed grade II-IV acute graft-versus-host disease (aGVHD), and 9.1% of patients died of severe gastrointestinal aGVHD. Of the 7 surviving patients, four were diagnosed with chronic GVHD. After a median follow-up of 28.9 months (2.0-52.1 months), four patients died: of relapse (two), aGVHD (one), and multiple-organ failure (one). The 2-year OS, DFS, and NRM were 63.6%, 45.4%, and 18.2%, respectively. Combination therapy with IVIG, dexamethasone, and a high dose of MNCs transfusion, a simple and efficient procedure, was safe and effective for DSA desensitization and peripheral blood stem cell (PBSC) engraftment.
供者特异性抗体（DSA）是单倍体相合造血干细胞移植（haplo-HSCT）中移植物排斥反应的重要原因。对于一些没有其他供者选择的患者来说，DSA是不可避免的。仍需要有效的干预措施来降低DSA，而目前治疗方法的费用相对较高。在本研究中，我们回顾性分析了在我们中心接受haplo-HSCT的11例DSA阳性患者的数据，并评估了静脉注射免疫球蛋白（IVIG）、地塞米松和高剂量输注单个核细胞（MNC）联合用于DSA脱敏的治疗效果。还观察了不同时间DSA的变化动态以及植入和移植结局。我们发现所有患者的供者细胞均成功植入，且无患者发生移植物功能不良。中性粒细胞和血小板的中位植入时间分别为14天（范围11 - 24天）和13天（范围11 - 123天）。所有患者的DSA水平在HSCT后22天内均转为阴性或降至2000以下。共有36.4%的患者发生了II - IV级急性移植物抗宿主病（aGVHD），9.1%的患者死于严重的胃肠道aGVHD。在7例存活患者中，4例被诊断为慢性GVHD。中位随访28.9个月（2.0 - 52.1个月）后，4例患者死亡：2例死于复发，1例死于aGVHD，1例死于多器官功能衰竭。2年总生存率（OS）、无病生存率（DFS）和非复发死亡率（NRM）分别为63.6%、45.4%和18.2%。IVIG、地塞米松和高剂量MNC输注的联合治疗是一种简单有效的方法，对DSA脱敏和外周血干细胞（PBSC）植入安全有效。
