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Rituximab for second desensitization in patients with rebound of donor-specific anti-HLA antibodies before T-replete haplo-transplant using high-dose post-transplant cyclophosphamide

Bone Marrow Transplantation volume 53, pages 1044–1047 (2018)Cite this article

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Letter to the editor

T-replete haplo-transplant using high-dose post transplant cyclophosphamide (PTCY) is increasingly used in patients without match related or unrelated donors [1]. However, the presence of donor-specific anti-HLA antibodies (DSA) in the recipient, which may be identified between 10 and 21% of patients, especially in multiparous females, may compromise the success of the procedure [2, 3]. Indeed, DSA have been associated with a high rate of primary graft failure (between 20 and 75%) or poor graft function after the haplo-transplant, despite the use of PTCY [2, 3] In fact, the search for recipient’s DSA is the first step to choose the best donor in a haploidentical-setting [4].Various tests are available to detect anti-HLA class I and II DSA, including solid-phase bead based immunoassays performed on a Luminex platform. Results are expressed as mean fluorescence intensity (MFI). No clear cutoff has been determined, indicating that DSA are likely to cause graft failure [2, 3]. Recently, C1q activation was developed to detect the complement-binding DSA (C1q-positive), which may predict that activation of the complement cascade will be responsible for donor cells destruction and graft rejection. C1q-positive test is generally correlated with high DSA levels and may be more appropriate to predict graft failure. However, only one study reported this result yet without any clear definition of C1q-positivity [5].

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Authors and Affiliations

  1. Hematology Department, Nantes University Hospital, Nantes, France

    Alice Garnier, Thierry Guillaume, Pierre Peterlin, Amandine Le Bourgeois, Philippe Moreau & Patrice Chevallier

  2. HLA Laboratory, EFS Pays de la Loire, Nantes, France

    Florent Delbos, Stéphanie Malard, Isabelle Gauvrit & Anne Cesbron

  3. Hematology/Biology Department, Nantes University Hospital, Nantes, France

    Marie C Béné & Yannick Le Bris

  4. Cellular Engineering Unit, EFS Pays de la Loire, Nantes, France

    Alix Duquesne

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  1. Alice Garnier
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Correspondence to Patrice Chevallier.

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Garnier, A., Delbos, F., Guillaume, T. et al. Rituximab for second desensitization in patients with rebound of donor-specific anti-HLA antibodies before T-replete haplo-transplant using high-dose post-transplant cyclophosphamide. Bone Marrow Transplant 53, 1044–1047 (2018). https://doi.org/10.1038/s41409-018-0107-7

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