Original article

Vol. 22 No. 2 (2024): Blood Transfusion 2-2024 (March-April)

Donor specific anti-HLA antibodies in hematopoietic stem cell transplantation. Single Center prospective evaluation and desensitization strategies employed

Authors

Key words: hematopoietic stem cell transplantation, anti-HLA antibodies, donor selection, engraftment, desensitization strategy

Abstract

Background - In the setting of mismatched-hematopoietic stem cells transplantation, the detection of antibodies directed against donor-specific HLA allele(s) or antigen(s) (DSA) represents a barrier for engraftment. It is thus necessary to plan an immunosuppressive strategy, or to select an alternative donor. This prospective study aimed at evaluating the efficacy of our strategy for testing DSAs and the efficacy of the desensitization strategy (DS) employed between November 2017 and November 2020.

Materials and methods - The anti-HLA antibody search was performed using the Luminex bead assays (Lifecode ID and LSA I/II-Immucor) and expressed as mean fluorescence intensity (MFI >1,000 positive). If the patient had DSAs and no alternative donors, a DS was employed with rituximab (day −15), 2 single volume plasmaphereses (PP; days −9 and −8), intravenous immunoglobulins (day −7) and infusion of HLA selected platelets, if persistent DSAs were directed against class I HLA. DS was scheduled with or without PP, according to the DSA MFI (>1,000 or <5,000) and FCXM (flow cytometry crossmatch).

Results - Twenty-two out of 126 patients (17.46%) showed anti-HLA antibodies, 5 of them DSAs (3.97% of total); 3 patients underwent DS obtaining engraftment. Female gender (p=0.033) and a history of previous pregnancies or miscarriages (p=0.009) showed a statistically significant impact on alloimmunization. Factors associated with a delayed neutrophil engraftment were patient’s female gender (p=0.039), stem cell source (p=0.025), and a high HSCT-specific comorbidity index (p=0.028). None of the analyzed variables, including the DSA detection, influenced engraftment.

Conclusions - Our study confirms the importance to test DSAs in mismatched-hematopoietic stem cells transplantation The DS used proved successful in removing DSAs. Prospective multicenter studies are needed to better define and validate consensus strategies on DSA management in HSCT.

Authors

Ursula La Rocca - Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy

Maria Paola Perrone - Immunohematology and Transfusion Medicine, Sapienza University, Rome, Italy

Alfonso Piciocchi - GIMEMA Foundation, Rome, Italy

Walter Barberi - Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy

Paola Gesuiti - Immunohematology and Transfusion Medicine, Sapienza University, Rome, Italy

Luca Laurenti - Immunohematology and Transfusion Medicine, Sapienza University, Rome, Italy

Paola Cinti - Immunohematology and Transfusion Medicine, Sapienza University, Rome, Italy

Maria Gozzer - Immunohematology and Transfusion Medicine, Sapienza University, Rome, Italy

Mahnaz Shafii Bafti - Immunohematology and Transfusion Medicine, Sapienza University, Rome, Italy

Daniela Carmini - Immunohematology and Transfusion Medicine, Sapienza University, Rome, Italy

Nadia Cinelli - Immunohematology and Transfusion Medicine, Sapienza University, Rome, Italy

Claudio Cavallari - Immunohematology and Transfusion Medicine, Sapienza University, Rome, Italy

Gianluca Giovannetti - Immunohematology and Transfusion Medicine, Sapienza University, Rome, Italy

Roberto Ricci - Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy

Gabriella Girelli - Immunohematology and Transfusion Medicine, Sapienza University, Rome, Italy

Robin Foà - Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy

Maurizio Martelli - Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy

Serelina Coluzzi - Immunohematology and Transfusion Medicine, Sapienza University, Rome, Italy

Anna Paola Iori - Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy

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