Donor Specific Anti-HLA Antibody and Risk of Graft Failure in Haploidentical Stem Cell Transplantation

Table 2

DSA desensitization in haploidentical and mismatched related AHSCT.

Reference	Donor type ()	Anti-HLA abs test	Desensitization method	MFI after treatment	Graft outcome
Barge et al. 1989 [41]	Haplo ()	CDC	Plasmapheresis	NA	Graft failure
Maruta et al. 1991 [52]	Mismatched related ()	AHG-CDC	CyA, methylpred, Plasmapheresis, DLI	Negative XM	Engrafted
Braun et al. 2000 [53]	Haplo ()	FCXM	Staphylococcal protein A immunoadsorption	Negative XM	Engrafted
Ottinger et al. 2002 [20]	Mismatched related ()	DTT-CDC	Plasmapheresis, mismatched platelet transfusion	1 patient with negative XM, 1 patient with positive XM	Patient with negative XM after treatment engrafted, while patients with positive XM had GF
Pollack and Ririe 2004 [54]	Mismatched HLA-A68 related ()	FCXM	Platelet transfusion, plasmapheresis, IVIg	Negative XM	Engrafted
Narimatsu et al. 2005 [55]	Mismatched related ()	AHG-LCT	Rituximab, platelet transfusion	Negative AHG-LCT	Engrafted
Ciurea et al. 2009 [22]	Haplo ()	Luminex MFI >500	Rituximab, plasmapheresis	1 negative, 1 low titer, 2 high titers	Patients with DSAs negative and low titer after treatment engrafted; 2 patients with high titer had GF
Yoshihara et al. 2012 [48]	Haplo ()	Luminex MFI >500	Plasmapheresis + rituximab (), platelet transfusion (), bortezomib + dexa ()	1 patient had temporary DSA reduction and 1 patient had significant reduction after plasmapheresis; 2 patients had a significant reduction post platelet transfusion; 1 patient had moderate DSA reduction after bortezomib and dexa	All patients engrafted
Ciurea et al. 2015 [46]	Haplo ()	Luminex; MFI >500	Plasmapheresis + rituximab + IVIg (),; PE + rituximab + IVIg + donor buffy coat infusion ()	No significant change of MFI before transplant; All patients cleared DSA after transplant	5 patients with C1q positive after treatment had GF while patients who became C1q negative engrafted
Leffell et al. 2015 [56]	Haplo (); MMUD ()	Luminex MFI >1000	Plasmapheresis + IVIg	Mean reduction of DSAs after treatment was 64.4%. 1 patient failed to reduce DSAs to the level that was thought to be safe for transplant	All 14/14 transplanted patients engrafted

MFI: mean fluorescence intensity; CDC: complement mediated cytotoxic; XM: crossmatch, FCXM: flow cytometric crossmatch, GF: graft failure; AHG-LCT: anti-human immunoglobulin lymphocytotoxicity test; NA: not available; MMUD: mismatched unrelated donor.