Table 3.
DSA desensitization in haploidentical and mismatched related AHCT (Adapted from Kongtim P, et al. Advances in hematology. 201690)
| Reference | Donor type (N) | Anti-HLA abs test | Desensitization method | MFI post-treatment | Graft outcome |
|---|---|---|---|---|---|
| Barge 198969 | Haplo (N=1) | CDC | Plasmapheresis | NA | Graft failure |
| Maruta 199184 | Mismatched related (N=1) | AHG-CDC | CyA, Methylprednisolone, Plasmapheresis, DLI | Negative XM | Engrafted |
| Braun 200085 | Haplo (N=1) | FCXM | Staphylococcal protein A immunoadsorption | Negative XM | Engrafted |
| Ottinger 200291 | Mismatched related (N=2) | DTT-CDC | Plasmapheresis, mismatched platelet transfusion | 1 patient with negative XM, 1 patient with positive XM | Patient with negative XM post-treatment engrafted, while patients with positive XM had GF |
| Pollack 200486 | Mismatched HLA-A68 related (N=1) | FCXM | Platelet transfusion, plasmapheresis, IVIg | Negative XM | Engrafted |
| Narimatsu 200592 | Mismatched related (N=1) | AHG-LCT | Rituximab, platelet transfusion | Negative AHG-LCT | Engrafted |
| Ciurea 200913 | Haplo (N=4) | Luminex MFI >500 | Plasmapheresis + rituximab | 1 negative, 1 low titer, 2 high titer | Patients with DSAs negative and low titer post treatment engrafted, 2 patients with high titer had GF |
| Yoshihara 201237 | Haplo (N=5) | Luminex MFI >500 | Plasmapheresis+ rituximab (N=2), platelet transfusions (N=2), bortezomib + dexamethasone (N=1) | 1 patient had temporary DSA reduction and 1 patient had significant reduction post plasmapheresis, 2 patients had a significant reduction post platelet transfusion, 1 patient had moderate DSA reduction after bortezomib and dexa. | All 5 patients engrafted |
| Ciurea 201534 | 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 post treatment had GF while patients who became C1q negative engrafted. |
| Leffell 201587 | Haplo (N=13) MMUD (N=2) |
Luminex MFI >1,000 | Plasmapheresis + IVIg + Tacrolimus | Mean reduction of DSAs post-treatment was 64.4%. 1 patient failed to reduce DSAs to the level that was thought to be safe for transplant. | 14/14 patients engrafted by Day+60 7 pts had relapsed disease |
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; IVIg – intravenous gammaglobulin; pts – patients.