Effects of anti-HLA donor-specific antibodies and desensitization on engraftment of haploidentical hematopoietic stem cell transplantation

Abstract

Objective To investigate the effects of anti-HLA donor-specific antibodies (DSA) and desensitization for DSA+patients on engraftment of haploidentical hematopoietic stem cell transplantation (haplo-HSCT). Methods The patients who underwent haplo-HSCT and examinations for HLA antibodies and DSA in our department from March 2017 to July 2023 were recruited in this study.The effects of desensitization measure on engraftment in the DSA+patients after haplo-HSCT were analyzed. Results Among the 70 patients who underwent haplo-HSCT and test for HLA antibodies, 15(21.4%) patients were DSA positive, including 7(46.7%) cases of strong positive, 3(20.0%) cases of moderate positive, and 5(33.3%) cases of weak positive.The median duration for neutrophil implantation was significantly extended in the DSA+patients than the negative patients (P=0.027).For the 6 patients developed graft failure (GF), 4 were DSA+which was statistically higher than the DSA-patients (P=0.025).Multivariate regression analysis showed that DSA was an independent factor affecting GF (HR=9.273, 95%CI: 1.505~57.124, P=0.016).Among the 10 patients (7 strong positive and 3 moderate positive DSA) received desensitization therapy, 4 patients received combination desensitization, with a 100% rate of successful transplantation, and 6 received single desensitization, with 4(66.7%) experiencing GF, so the GF rate was obviously lower in the combination than the single desensitization (P=0.008). Conclusion In haplo-HSCT patients, DSA is an important factor leading to implantation delay and GF.While, single desensitization treatment has limited efficacy.In combined DSA desensitization therapy, the decrease of antibody titer should be dynamically monitored to ensure the successful implantation of stem cells and reduce GF rate.

Keywords

• anti-hla donor-specific antibodies
• haploidentical hematopoietic stem cell transplantation
• graft failure
• desensitization measure