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. 2024 Mar;22(2):157-165.
doi: 10.2450/BloodTransfus.464. Epub 2023 Sep 21.

Donor specific anti-HLA antibodies in hematopoietic stem cell transplantation. Single Center prospective evaluation and desensitization strategies employed

Ursula La Rocca  1 , Maria P Perrone  2 , Alfonso Piciocchi  3 , Walter Barberi  1 , Paola Gesuiti  2 , Luca Laurenti  2 , Paola Cinti  2 , Maria Gozzer  2 , Manhaz Shafii Bafti  2 , Daniela Carmini  2 , Nadia Cinelli  2 , Claudio Cavallari  1 , Gianluca Giovannetti  2 , Roberto Ricci  1 , Gabriella Girelli  2 , Robin Foà  1 , Maurizio Martelli  1 , Serelina Coluzzi  2 , Anna P Iori  1
Affiliations

Donor specific anti-HLA antibodies in hematopoietic stem cell transplantation. Single Center prospective evaluation and desensitization strategies employed

Ursula La Rocca et al. Blood Transfus. 2024 Mar.

Abstract

Background: In the setting of mismatched-hematopoietic stem cells transplantation, the detection of antibodies directed against donor-specific HLA allele(s) or antigen(s) (DSA) represents a barrier for engraftment. It is thus necessary to plan an immunosuppressive strategy, or to select an alternative donor. This prospective study aimed at evaluating the efficacy of our strategy for testing DSAs and the efficacy of the desensitization strategy (DS) employed between November 2017 and November 2020.

Materials and methods: The anti-HLA antibody search was performed using the Luminex bead assays (Lifecode ID and LSA I/II-Immucor) and expressed as mean fluorescence intensity (MFI >1,000 positive). If the patient had DSAs and no alternative donors, a DS was employed with rituximab (day -15), 2 single volume plasmaphereses (PP; days -9 and -8), intravenous immunoglobulins (day -7) and infusion of HLA selected platelets, if persistent DSAs were directed against class I HLA. DS was scheduled with or without PP, according to the DSA MFI (>1,000 or <5,000) and FCXM (flow cytometry crossmatch).

Results: Twenty-two out of 126 patients (17.46%) showed anti-HLA antibodies, 5 of them DSAs (3.97% of total); 3 patients underwent DS obtaining engraftment. Female gender (p=0.033) and a history of previous pregnancies or miscarriages (p=0.009) showed a statistically significant impact on alloimmunization. Factors associated with a delayed neutrophil engraftment were patient's female gender (p=0.039), stem cell source (p=0.025), and a high HSCT-specific comorbidity index (p=0.028). None of the analyzed variables, including the DSA detection, influenced engraftment.

Conclusions: Our study confirms the importance to test DSAs in mismatched-hematopoietic stem cells transplantation The DS used proved successful in removing DSAs. Prospective multicenter studies are needed to better define and validate consensus strategies on DSA management in HSCT.

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Conflict of interest statement

The Authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Desensitization strategy ATG: anti-thymocyte globulin; HSCT: hematopoietic stem cell transplantation; IVIG: intravenous immunoglobulin; PLT: platelet PP: plasmapheresis; PT: plasma-treatment.
Figure 2
Figure 2
Median follow-up, OS and TRM OS: overall survival; TRM: transplant related mortality.
See this image and copyright information in PMC

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