Management of Donor-Specific Antibodies in Haploidentical Transplant: Multicenter Experience From the Madrid Group of Hematopoietic Transplant.
Management of Donor-Specific Antibodies in Haploidentical Transplant: Multicenter Experience From the Madrid Group of Hematopoietic Transplant.
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DOI：
10.3389/fimmu.2021.674658
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发表时间：
2021
影响因子：
7.3
通讯作者：
Kwon M
中科院分区：
文献类型：
--
作者：
Bailén R;Vicario JL;Solán L;Sánchez-Vadillo I;Herrera P;Calbacho M;Alenda R;López-Lorenzo JL;Humala K;Chinea A;Sánchez-Pina J;Balas A;Moreno MÁ;Arzuaga J;Pradillo V;Dorado N;Oarbeascoa G;Anguita J;Díez-Martín JL;Kwon M
供者特异性抗体(DSA)可能是不相合造血干细胞移植(HSCT)中移植物失败(GF)的原因。我们研究的目的是报告马德里造血移植小组(GMTH)在接受单系造血干细胞移植的DSA患者中的经验。这项研究包括2012至2020年间在GMTH中心接受单核细胞造血干细胞移植的患者。DSA用固相单抗原免疫测定法进行分析；脱敏期间在脱敏过程中进行监测，并每周监测一次，直到中性粒细胞植入。脱敏策略取决于中枢经验、免疫荧光强度、补体结合和抗体类型。我们在5个中心的19名接受DSA治疗的患者中发现了20例单核细胞移植。抗HLAI类DSA 10例(53%)，抗HLAII类4例(21%)，同时抗HLAI和II类5例(26%)。90%的患者接受了至少两次脱敏治疗，所有患者脱敏后MFI均有下降(平均下降74%)。仅1例输液后MFI进行性增加的患者发生了GF。脱敏治疗包括利妥昔单抗、免疫球蛋白、治疗性血浆置换、血型不合的血小板、黄褐色涂层和免疫抑制剂。17例(90%)患者实现了中性粒细胞植入；1例患者在植入前因感染死亡，1例I类DSA患者尽管进行了强烈的脱敏治疗，但仍发展为原发的GF。中位随访10个月，OS和EFS分别为60%和58%，累积复发率为5%，NRM为32%。尽管DSAs脱敏的最佳策略尚不清楚，但在DSAs强度动力学指导下进行脱敏治疗，对于需要替代合适供体的DSAs患者来说，是一种植入率高的有效方法。
Donor specific antibodies (DSAs) can be responsible for graft failure (GF) in the setting of mismatched hematopoietic stem cell transplantation (HSCT). The aim of our study is to report the experience of the Madrid Group of Hematopoietic Transplant (GMTH) in patients with DSAs undergoing haplo-HSCT. Patients undergoing haplo-HSCT in centers from the GMTH from 2012 to 2020 were included in the study. DSAs were analyzed with a solid-phase single-antigen immunoassay; monitoring was performed during desensitization on days -14, -7, 0 and in a weekly basis until neutrophil engraftment. Desensitization strategies varied depending on center experience, immunofluorescence intensity, complement fixation and type of antibodies. We identified a total of 20 haplo-HSCT in 19 patients performed with DSAs in 5 centers. 10 (53%) patients presented anti-HLA class I DSAs (6 of them with > 5000 mean fluorescence intensity (MFI)), 4 (21%) presented anti-HLA class II (1 with > 5000 MFI) and 5 (26%) presented both anti-HLA class I and II (5 with > 5000 MFI). 90% of patients received at least two treatments as desensitization strategy and all experienced a decrease of MFI after desensitization (mean reduction 74%). Only one patient who developed progressive increase of MFI after infusion developed GF. Desensitization treatments used included rituximab, immunoglobulins, therapeutic plasma exchange, incompatible platelets, buffy coat and immunosuppressors. Seventeen (90%) patients achieved neutrophil engraftment; one patient died before engraftment because of infection and one patient with class I DSAs developed primary GF despite an intensive desensitization. After a median follow-up of 10 months, OS and EFS were 60% and 58%, respectively, cumulative incidence of relapse was 5% and NRM was 32%. Despite the optimal strategy of DSAs desensitization remains unclear, the use of desensitization treatment guided by DSAs intensity kinetics constitute an effective approach with high rates of engraftment for patients with DSAs in need for an haplo-HSCT lacking an alternative suitable donor.
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影响因子：
4.8
作者：
Mohty M;Malard F;Abecassis M;Aerts E;Alaskar AS;Aljurf M;Arat M;Bader P;Baron F;Bazarbachi A;Blaise D;Ciceri F;Corbacioglu S;Dalle JH;Dignan F;Fukuda T;Huynh A;Masszi T;Michallet M;Nagler A;NiChonghaile M;Okamoto S;Pagliuca A;Peters C;Petersen FB;Richardson PG;Ruutu T;Savani BN;Wallhult E;Yakoub-Agha I;Duarte RF;Carreras E
通讯作者：
Carreras E
DOI：
10.1016/j.bbmt.2015.05.001
发表时间：
2015-08
期刊：
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
影响因子：
--
作者：
Ciurea SO;Thall PF;Milton DR;Barnes TH;Kongtim P;Carmazzi Y;López AA;Yap DY;Popat U;Rondon G;Lichtiger B;Aung F;Afshar-Kharghan V;Ma Q;Fernández-Viña M;Champlin RE;Cao K
通讯作者：
Cao K
影响因子：
20.3
作者：
Armand, Philippe;Kim, Haesook T.;Saber, Wael
通讯作者：
Saber, Wael
影响因子：
20.3
作者：
Ciurea, Stefan O.;Thall, Peter F.;Fernandez-Vina, Marcelo
通讯作者：
Fernandez-Vina, Marcelo
影响因子：
4.8
作者：
Olsson, R.;Remberger, M.;Ringden, O.
通讯作者：
Ringden, O.