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Donor HLA-specific Abs: to BMT or not to BMT?

Bone Marrow Transplantation volume 50, pages 751–758 (2015)Cite this article

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Abstract

The engraftment failure associated with Abs to donor-specific HLA (DSA) limits options for sensitized BMT candidates. Fourteen of fifteen patients with no other viable donor options were desensitized and transplanted using a regimen of plasmapheresis and low-dose i.v. Ig modified to accommodate pre-BMT conditioning. DSA levels were assessed by solid-phase immunoassays and cell-based crossmatch tests. DSA levels were monitored throughout desensitization and on day −1 to determine if there was any DSA rebound that would require additional treatment. A mean reduction in DSA level of 64.4% was achieved at the end of desensitization, with a subsequent reduction of 85.5% after transplantation. DSA in 11 patients was reduced to levels considered negative post-BMT, whereas DSA in three patients remained at low levels. All 14 patients achieved donor engraftment by day +60; however, seven patients suffered disease relapses. Four patients experienced mild, grade 1 GVHD. Factors influencing the response to desensitization include initial DSA strength, number, specificity, DSA rebound and a mismatch repeated from a prior transplant. While desensitization should be reserved for patients with limited donor options, careful DSA assessment and monitoring can facilitate successful engraftment after BMT.

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Authors and Affiliations

  1. Department of Medicine, Immunogenetics Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    M S Leffell

  2. Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Medicine, Baltimore, MD, USA

    R J Jones & D E Gladstone

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  1. M S Leffell
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Correspondence to M S Leffell.

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Leffell, M., Jones, R. & Gladstone, D. Donor HLA-specific Abs: to BMT or not to BMT?. Bone Marrow Transplant 50, 751–758 (2015). https://doi.org/10.1038/bmt.2014.331

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