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Successful engraftment in crossmatch-positive HLA-mismatched peripheral blood stem cell transplantation after depletion of antidonor cytotoxic HLA antibodies with rituximab and donor platelet infusion

Bone Marrow Transplantation volume 36, pages 555–556 (2005)Cite this article

Hematopoietic stem cell transplantation from a relative HLA-mismatched donor is one option for patients who do not have an immediately available HLA-identical donor and who cannot wait for an appropriate match to be found.1 However, in such patients graft rejection is one of several significant problems.1 The immunologic mechanism of graft rejection is thought to be a complex process involving host-derived donor-specific T cells, natural killer cells,2, 3 and antibody-producing cells.4 Evidence has been accumulating that the presence of donor-reactive HLA antibodies plays an important role in solid organ graft rejection.5 Therefore, HLA antibodies need to be removed in order to avoid graft rejection in patients who present with a positive crossmatch for anti-donor lymphocytotoxic antibody. However, routine procedures for carrying out this have not been established.6

A 34-year-old woman was referred to our hospital in September 2004 for allogeneic hematopoietic transplantation. She had developed acute myeloid leukemia in June 2004 that was refractory to induction therapy with cytarabine and anthracycline. She had no available HLA-identical family donors, and it was determined that, due to disease progression, there was not enough time to await a match from the Japan marrow donor program. There was also no cord blood containing ⩾2.0 × 107/kg of nucleated cells available in the Japan Cord Blood Bank Network. She had a healthy, partially HLA-mismatched brother, with two-locus mismatches in the host-versus-graft direction and one-locus mismatch in the graft-versus-host direction (Table 1). Peripheral blood stem cell transplantation (PBSCT) from the brother was planned immediately. However, the patient was found to have HLA antibodies against HLA-A2, which is one of the donor-specific antigens in the host-versus-graft reaction. Her serum showed a positive crossmatch with the lymphocytes obtained from her brother.

Table 1 HLA typing of patient and donor
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Authors and Affiliations

  1. Department of Hematology, Toranomon Hospital, Tokyo, Japan

    H Narimatsu, A Wake, Y Miura, T Matsumura, S Takagi, D Kato, T Myojo, E Kusumi, K Masuoka, S Miyakoshi, S Morinaga & S Taniguchi

  2. The Japanese Red Cross Tokyo Blood Center, Tokyo, Japan

    H Tanaka

  3. HLA Laboratory, NPO, Kyoto, Japan

    H Saji

  4. Department of Hematology/Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    T Ichinohe

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  1. H Narimatsu
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Narimatsu, H., Wake, A., Miura, Y. et al. Successful engraftment in crossmatch-positive HLA-mismatched peripheral blood stem cell transplantation after depletion of antidonor cytotoxic HLA antibodies with rituximab and donor platelet infusion. Bone Marrow Transplant 36, 555–556 (2005). https://doi.org/10.1038/sj.bmt.1705070

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