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La Rocca U, Perrone MP, Piciocchi A, Barberi W, Gesuiti P, Laurenti L, Cinti P, Gozzer M, Bafti MS, Carmini D, Cinelli N, Cavallari C, Giovannetti G, Ricci R, Girelli G, Foà R, Martelli M, Coluzzi S, Iori AP. Donor specific anti-HLA antibodies in hematopoietic stem cell transplantation. Single Center prospective evaluation and desensitization strategies employed. Blood Transfus 2024; 22:157-165. [PMID: 37847211 PMCID: PMC10920073 DOI: 10.2450/bloodtransfus.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 07/09/2023] [Indexed: 10/18/2023]
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.
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Affiliation(s)
- Ursula La Rocca
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Maria P. Perrone
- Immunohematology and Transfusion Medicine, Sapienza University, 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
| | | | - Daniela Carmini
- Immunohematology and Transfusion Medicine, Sapienza University, Rome, Italy
| | - Nadia Cinelli
- Immunohematology and Transfusion Medicine, Sapienza University, Rome, Italy
| | - Claudio Cavallari
- Hematology, Department of Translational and Precision 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 P. Iori
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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Screnci M, Murgi E, Carmini D, Piro L, Cinelli N, Laurenti L, Iori AP, Simone F, Massari S, Girelli G. Related cord blood banking for haematopoietic stem cell transplantation. Transfus Med 2010; 20:185-90. [DOI: 10.1111/j.1365-3148.2009.00983.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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