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Treatment of donor-specific antibody-mediated graft rejection by immunochemotherapy, third-party DLI, plasmapheresis and immunoadsorption

Bone Marrow Transplantation volume 50, pages 613–614 (2015)Cite this article

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In allogenic SCT, patient-derived donor-specific HLA antibody (DSA)-mediated graft rejection is a rare, but serious complication. Gergis et al.1 recently described a new therapeutic approach to reduce pre-existing DSA before allogeneic transplantation to enhance the likelihood of engraftment in 10 patients. They combined pretransplant extracorporeal antibody elimination by plasmapheresis with immunochemotherapy (rituximab, bortezomib and/or intravenous immunglobuline (i.v.IG)) and thereby achieved substantial reduction in DSA titers with sustained engraftment in nine patients.

We here report the case of a patient suffering from primary graft failure due to elevated DSA titers. Although a combination of pretransplant immunochemotherapy and third-party DLI with plasmapheresis seemed to be inefficient in reducing DSA titers alone, immunoadsorption additionally performed in the post- transplant period might have helped to achieve sufficient DSA titer reduction, thereby facilitating sustained engraftment.

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References

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Authors and Affiliations

  1. Department of Hematology, Oncology and Clinical Immunology, University Hospital Düsseldorf, Medical Faculty, Düsseldorf, Germany

    C M Wilk, R Haas, G Kobbe & T Schroeder

  2. Institute for Transplantation Diagnostics and Cell Therapeutics, University Hospital Düsseldorf, Medical Faculty, Düsseldorf, Germany

    J C Fischer & J M Rox

  3. Department of Nephrology, University Hospital Düsseldorf, Medical Faculty, Düsseldorf, Germany

    G Schieren & L C Rump

Authors
  1. C M Wilk
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  2. J C Fischer
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  3. G Schieren
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  4. J M Rox
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  5. R Haas
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  6. L C Rump
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  7. G Kobbe
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  8. T Schroeder
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Correspondence to T Schroeder.

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The authors declare no conflict of interest.

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Supplementary Information accompanies this paper on Bone Marrow Transplantation website

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Wilk, C., Fischer, J., Schieren, G. et al. Treatment of donor-specific antibody-mediated graft rejection by immunochemotherapy, third-party DLI, plasmapheresis and immunoadsorption. Bone Marrow Transplant 50, 613–614 (2015). https://doi.org/10.1038/bmt.2014.321

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