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Effective desensitization of donor-specific HLA antibodies using platelet transfusion bearing targeted HLA in a case of HLA-mismatched allogeneic stem cell transplantation

Bone Marrow Transplantation volume 52, pages 794–796 (2017)Cite this article

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HLA antibodies are produced on exposure to allogeneic HLAs in pregnancies or blood transfusions.1 Several lines of evidence support the notion that HLA antibodies, especially donor-specific HLA antibodies (DSA), interfere with hematopoietic engraftment in HLA-mismatched allogeneic hematopoietic stem cell transplantation (HSCT).2, 3, 4, 5, 6, 7 The engraftment rate in DSA-positive recipients was reported to be 32–44% and 61–68% in umbilical cord blood transplantation and HLA-mismatched transplantation from family members (haploHSCT), respectively. In the cord blood transplantation setting, a cord blood unit that does not have DSA-targeted HLA is usually selected; on the other hand, in the haploHSCT setting, HSCT from the donor with DSA-targeted HLA is often inevitable because of the lack of another candidate donor, as seen in the situation of organ transplantation. Actually, the desensitization of HLA antibodies in HLA-incompatible kidney recipients led to significant survival benefit after live donor kidney transplantation.8

Methods to desensitize HLA antibodies are classified into the following three types: (1) targeting B cells and plasma cells (rituximab, bortezomib and so on), (2) removal or depletion of HLA antibodies (plasma exchange, transfusions of platelet or buffy coat bearing the DSA-targeted HLA and so on), (3) modification of Ab-mediated reaction (IVIg, eculizumab and so on).9 Although single and combined methods have been applied in the clinical field of hematopoietic transplantation, the efficacy of these methods remains to be determined. We prefer to use rituximab to prevent the de novo synthesis of HLA antibodies, and IVIg to suppress the Ab-mediated immune reaction, followed by transfusion of platelet concentrate expressing DSA-targeted HLA (DSA-PC) to deplete the pre-existing DSA.5 In this case report, we chronologically monitored the titer of HLA antibodies every 1 h during and after the DSA-PC transfusion, and noted a marked attenuation of not only DSA (anti-HLA B*40:02 Ab) but also other HLA antibodies targeting HLAs containing an epitope, 163EW, which was shared with HLA B*40:02.

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Authors and Affiliations

  1. Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan

    T Yamashita, K Ikegame, K Kaida, T Inoue & H Ogawa

  2. Department of Hematology, Nephrology and Rheumatology, Graduate School of Medicine, Akita University, Akita, Japan

    T Yamashita

  3. HLA Foundation Laboratory, Kyoto, Japan

    H Kojima & H Tanaka

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  1. T Yamashita
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Correspondence to K Ikegame.

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Yamashita, T., Ikegame, K., Kojima, H. et al. Effective desensitization of donor-specific HLA antibodies using platelet transfusion bearing targeted HLA in a case of HLA-mismatched allogeneic stem cell transplantation. Bone Marrow Transplant 52, 794–796 (2017). https://doi.org/10.1038/bmt.2017.10

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