Desensitization with plasma exchange in a patient with human leukocyte antigen donor-specific antibodies before T-cell-replete haploidentical transplantation

Stefania Bramanti; Angela Nocco; Elisa Mauro; Giuseppe Milone; Lucio Morabito; Barbara Sarina; Roberto Crocchiolo; Inna Timofeeva; Rossana Capizzuto; Carmelo Carlo-Stella; Armando Santoro; Luca Castagna

doi:10.1111/trf.13523

Desensitization with plasma exchange in a patient with human leukocyte antigen donor-specific antibodies before T-cell-replete haploidentical transplantation

Transfusion. 2016 May;56(5):1096-1100. doi: 10.1111/trf.13523. Epub 2016 Mar 28.

Affiliations

¹ Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy.
² Immuno-Hematology Laboratory, IRCCS Ospedale Maggiore, Milano, Italy.
³ Transplant Unit Ospedale Ferrarotto, Catania, Italy.
⁴ Hematology Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy.

PMID: 27021516
DOI: 10.1111/trf.13523

Abstract

Background: The presence of human leukocyte antigen donor-specific antibodies (DSAs) increases the risk of graft failure in T-cell-replete haploidentical hematopoietic stem cell transplantation (haplo-HSCT) CASE REPORT: A 49-year-old female with high-risk acute myeloid leukemia in first complete remission received a haplo-HSCT from her daughter. Pretransplant recipient screening examination showed high DSAs levels against unshared class I leukocyte antigens.

Results: The patient underwent a desensitization program consisting of plasma exchange (PEX), polyvalent intravenous (IV) immunoglobulins, and IV tacrolimus and mycophenolate mofetil (MMF). This protocol resulted in the disappearance of the DSA anti HLA B41. Engraftment was prompt with stable full donor chimerism.

Conclusions: This case report suggests that the adopted scheme is safe for reducing DSA levels and facilitating donor engraftment in patients scheduled for haplo-HSCT.

Publication types

Case Reports