Dear editor,
We read with interest the article by Sharma et al. [1] showing the updated consensus of the main highlights presented at the annual meeting of American Society of Transplantation and Cellular Therapy. We applaud experts for summarizing the latest research in the hematopoietic stem cell transplantation.
Regarding haploidentical hematopoietic stem cell transplantation (Haplo-HSCT), authors commented to take into account different parameters of donor selection as: age, ABO or KIR-genotype mismatches. Furthermore, they treated patients pre-transplant with plasma exchange and rituximab if they had donor-specific HLA antibodies (DSA) [1]. This concept is also showed on the Consensus Guidelines for the Detection and Treatment of DSA of The European Society for Blood and Marrow Transplantation (EBMT) [2]. However, we believe special attention should be brought to characterize the nature of DSA because if they are able to engage the complement system we would suggest considering other person as potential donor. In our laboratory the IgG DSA testing and C1q testing are performed on a Luminex platform with single antigen bead assay.
A review of the literature provides evidence that DSA are associated with a twofold to tenfold increase of graft failure of Haplo-HSCT, irrespective the type of the graft, or the patient conditioning [3]. In addition, as Chang mentioned, DSA should be the first step in donor selection of HLA mismatched HSCT [4]. Moreover DSA levels (> 5000 MFI) and complement-binding DSA antibodies (C1q positive) appear to be at much higher risk of primary graft failure [5]. So, according with bibliography and our experience too, we have developed an algorithm to go into detail about the patient HLA-antibodies study (Fig. 1). To sum up, this letter pretends to emphasize a new concept because if DSA are C1q positive we strongly suggest, not to waste time and effort in desensitization strategies, because this donor should not be accepted for Haplo-HSCT. This fact is one of the most important decisions for Haplo-HSCT success.
Fig. 1.
BC Buffy coat, CDC complement-dependent cytotoxicity, C1q C1q testing, DSA donor-specific HLA antibodies, HSCT hematopoietic stem cell transplantation, MFI median fluorescence intensity, PE plasma exchange, R rituximab
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References
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