Desensitization with plasma exchange in a patient with human leukocyte antigen donor-specific antibodies before T-cell-replete haploidentical hematopoietic stem cell transplantation

Abstract

The presence of human leukocyte antigen (HLA) donor-specific antibodies (DSAs) increases the risk of graft failure in T-cell-replete haploidentical hematopoietic stem cell transplantation (haploidentical-HSCT). We report a case of a 20-year-old male with high-risk thalassemia major who received a haploidentical-HSCT from his mother. Pretransplant recipient screening examination showed positive DSA levels against class I and class II HLAs. The patient underwent a desensitization program consisting of plasma exchange and polyvalent intravenous immunoglobulins. This protocol resulted in the disappearance of DSA class I and reduction in Mean Fluorescence Intensity (MFI) class II antibodies. Engraftment was prompt with stable full donor chimerism. This case report suggests that the adopted scheme is safe for reducing DSA levels and facilitating donor engraftment in patients scheduled for haploidentical-HSCT, though it needs evaluation in a large cohort of patients.

Keywords

• Desensitization
• donor chimerism
• donor-specific antibodies
• haploidentical hematopoietic stem cell transplantation