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The impact of HLA donor-specific antibodies on engraftment and the evolving desensitization strategies

Bone Marrow Transplantation volume 57, pages 526–531 (2022)Cite this article

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Abstract

The majority of contemporary allogeneic hematopoietic stem cell transplantation (HCT) procedures utilize partially HLA-mismatched stem cell grafts. Donor-specific anti-HLA antibodies (DSA) are associated with primary graft failure independent of the graft source, conditioning intensity and other patient and donor factors. Here we provide an update on testing and monitoring of DSA, review the impact of DSA on stem cell engraftment, and present promising desensitization modalities. Ultimately, we attempt to provide practical recommendations for DSA screening and mitigation strategies.

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Fig. 1: Our proposed DSA desensitization protocol for patients with DSA >2000 MFI.

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Acknowledgements

The authors wish to thank Mia Gergis (Department of Psychology, Tufts University, Boston, Massachusetts) for her copywriting and editing contribution.

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Authors and Affiliations

  1. Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA

    Brittany File

  2. Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA

    Yanping Huang & Alexis Peedin

  3. Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA

    Usama Gergis

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Contributions

BF: researched the topic and wrote the manuscript. AP and YH: contributed the sections on plasmapheresis, platelets transfusion and DSA monitoring. UG: conceptualized the topic, contributed the sections on DSA desensitization and provided senior guidance. All authors approved the final version of the manuscript.

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Correspondence to Usama Gergis.

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File, B., Huang, Y., Peedin, A. et al. The impact of HLA donor-specific antibodies on engraftment and the evolving desensitization strategies. Bone Marrow Transplant 57, 526–531 (2022). https://doi.org/10.1038/s41409-022-01578-w

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