1. Desensitization with plasma exchange in a patient with human leukocyte antigen donor-specific antibodies before T-cell-replete haploidentical transplantation
- Author
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Angela Nocco, Barbara Sarina, Carmelo Carlo-Stella, Lucio Morabito, Elisa Mauro, R. Capizzuto, Giuseppe Milone, Roberto Crocchiolo, Armando Santoro, Stefania Bramanti, I Timofeeva, and Luca Castagna
- Subjects
biology ,business.industry ,medicine.medical_treatment ,Immunology ,Myeloid leukemia ,Hematology ,Hematopoietic stem cell transplantation ,Human leukocyte antigen ,Mycophenolate ,Tacrolimus ,03 medical and health sciences ,surgical procedures, operative ,0302 clinical medicine ,Antigen ,030220 oncology & carcinogenesis ,medicine ,biology.protein ,Immunology and Allergy ,Antibody ,business ,030215 immunology ,Desensitization (medicine) - Abstract
BACKGROUND The presence of human leukocyte antigen donor-specific antibodies (DSAs) increases the risk of graft failure in T-cell–replete haploidentical hematopoietic stem cell transplantation (haplo-HSCT) CASE REPORT A 49-year-old female with high-risk acute myeloid leukemia in first complete remission received a haplo-HSCT from her daughter. Pretransplant recipient screening examination showed high DSAs levels against unshared class I leukocyte antigens. RESULTS The patient underwent a desensitization program consisting of plasma exchange (PEX), polyvalent intravenous (IV) immunoglobulins, and IV tacrolimus and mycophenolate mofetil (MMF). This protocol resulted in the disappearance of the DSA anti HLA B41. Engraftment was prompt with stable full donor chimerism. CONCLUSIONS This case report suggests that the adopted scheme is safe for reducing DSA levels and facilitating donor engraftment in patients scheduled for haplo-HSCT.
- Published
- 2016