Table 2.
DSA desensitization in haploidentical and mismatched related AHSCT.
| Reference | Donor type (N) | Anti-HLA abs test | Desensitization method | MFI after treatment | Graft outcome |
|---|---|---|---|---|---|
| Barge et al. 1989 [41] | Haplo (N = 1) | CDC | Plasmapheresis | NA | Graft failure |
|
| |||||
| Maruta et al. 1991 [52] | Mismatched related (N = 1) | AHG-CDC | CyA, methylpred, Plasmapheresis, DLI | Negative XM | Engrafted |
|
| |||||
| Braun et al. 2000 [53] | Haplo (N = 1) | FCXM | Staphylococcal protein A immunoadsorption | Negative XM | Engrafted |
|
| |||||
| Ottinger et al. 2002 [20] | Mismatched related (N = 2) | DTT-CDC | Plasmapheresis, mismatched platelet transfusion | 1 patient with negative XM, 1 patient with positive XM | Patient with negative XM after treatment engrafted, while patients with positive XM had GF |
|
| |||||
| Pollack and Ririe 2004 [54] | Mismatched HLA-A68 related (N = 1) | FCXM | Platelet transfusion, plasmapheresis, IVIg | Negative XM | Engrafted |
|
| |||||
| Narimatsu et al. 2005 [55] | Mismatched related (N = 1) | AHG-LCT | Rituximab, platelet transfusion | Negative AHG-LCT | Engrafted |
|
| |||||
| Ciurea et al. 2009 [22] | Haplo (N = 4) | Luminex MFI >500 | Rituximab, plasmapheresis | 1 negative, 1 low titer, 2 high titers | Patients with DSAs negative and low titer after treatment engrafted; 2 patients with high titer had GF |
|
| |||||
| Yoshihara et al. 2012 [48] | Haplo (N = 5) | Luminex MFI >500 | Plasmapheresis + rituximab (N = 2), platelet transfusion (N = 2), bortezomib + dexa (N = 1) |
1 patient had temporary DSA reduction and 1 patient had significant reduction after plasmapheresis; 2 patients had a significant reduction post platelet transfusion; 1 patient had moderate DSA reduction after bortezomib and dexa | All patients engrafted |
|
| |||||
| Ciurea et al. 2015 [46] | Haplo (N = 12) | Luminex MFI >500 |
Plasmapheresis + rituximab + IVIg (N = 5), PE + rituximab + IVIg + donor buffy coat infusion (N = 7) |
No significant change of MFI before transplant All patients cleared DSA after transplant |
5 patients with C1q positive after treatment had GF while patients who became C1q negative engrafted |
|
| |||||
| Leffell et al. 2015 [56] | Haplo (N = 13) MMUD (N = 2) |
Luminex MFI >1000 | Plasmapheresis + IVIg | Mean reduction of DSAs after treatment was 64.4%. 1 patient failed to reduce DSAs to the level that was thought to be safe for transplant | All 14/14 transplanted patients engrafted |
MFI: mean fluorescence intensity; CDC: complement mediated cytotoxic; XM: crossmatch, FCXM: flow cytometric crossmatch, GF: graft failure; AHG-LCT: anti-human immunoglobulin lymphocytotoxicity test; NA: not available; MMUD: mismatched unrelated donor.