Management of Allo-sensitized HCT Patients

Ciuera SO, Al Malki MM, Kongtim P, et al. Treatment of Allosensitized Patients Receiving Allogeneic Transplantation. Blood Advances. 2021; (doi: 0.1182/bloodadvances.2021004862). A treatment regimen including alternate day plasma exchange, rituximab, intravenous gamma globulin, and an irradiated donor buffy coat is more likely to promote engraftment in patients undergoing haploidentical stem cell transplantation (HaploSCT) with donor-specific anti-human leukocyte antigen antibodies (DSA) <20,000 mean fluorescence intensity (MFI). The researchers administered this desensitization procedure to 37 patients with a mean age of 51 years, and compared the treatment outcomes with those observed in 345 HaploSCT patients without DSA. In all, 83.8% of the DSA group was female, vs. 37.1% of the controls, and 67.6% received stem cells from a child as donor, vs. 44.1% of the controls. The mean pre- and post-desensitization DSA levels were 10,198 and 5,937 MFI, respectively, with a mean difference of 4,030 MFI. Complement component 1q positivity (C1q+) was seen in 46.7% of tested patients (14 of 30) and maintained in 27.6% (8 of 29) following desensitization. Based on multivariable analysis, patients exhibiting initial DSA >20,000 MFI and persistent C1q+ after desensitization treatment saw less effective engraftment, higher non-relapse mortality, and worse overall survival compared with controls. For patients with initial DSA <20,000 MFI and those with negative C1q following treatment, graft outcome and survival were comparable with controls, the researchers report.

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