The efficacy and safety of protein A immunoadsorption combined with rituximab treatment for highly sensitized patients undergoing haplo-hematopoietic stem cell transplantation
10.3760/cma.j.cn121090-20231125-00277
- VernacularTitle:高致敏单倍体造血干细胞移植患者采用蛋白A免疫吸附联合利妥昔单抗行脱敏治疗的疗效及安全性
- Author:
Ling LI
1
;
Wenjuan ZHU
;
Qian ZHU
;
Shiyuan ZHOU
;
Chao MA
;
Jun WANG
;
Xiaohui HU
;
Yue HAN
;
Ying WANG
;
Xiaowen TANG
;
Xiao MA
;
Suning CHEN
;
Huiying QIU
;
Luyao CHEN
;
Jun HE
;
Depei WU
;
Xiaojin WU
Author Information
1. 苏州大学附属第一医院血液内科，国家血液系统疾病临床医学研究中心，江苏省血液研究所，苏州大学造血干细胞移植研究所，苏州 215006
- Keywords:
Immunosorbent techniques;
Hematopoietic stem cell transplantation;
Desensitization, treatment;
Rituximab
- From:
Chinese Journal of Hematology
2024;45(5):468-474
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the efficacy and safety of protein A immunoadsorption (PAIA) combined with rituximab (RTX) in highly sensitized patients who underwent haplo-hematopoietic stem cell transplantation (haplo-HSCT) .Methods:The clinical data of 56 highly sensitized patients treated with PAIA and RTX before haplo-HSCT at the First Affiliated Hospital of Soochow University and Soochow Hopes Hematonosis Hospital between March 2021 and June 2023 were retrospectively analyzed. The number of human leukocyte antigen (HLA) antibody types and the mean fluorescence intensity (MFI), humoral immunity, adverse reactions during adsorption, and survival within 100 days before and after adsorption were measured.Results:After receiving the PAIA treatment, the median MFI of patients containing only HLA Ⅰ antibodies decreased from 7 859 (3 209-12 444) to 3 719 (0-8 275) ( P<0.001), and the median MFI of HLA Ⅰ+Ⅱ antibodies decreased from 5 476 (1 977-12 382) to 3 714 (0-11 074) ( P=0.035). The median MFI of patients with positive anti-donor-specific antibodies decreased from 8 779 (2 697-18 659) to 4 524 (0–15 989) ( P<0.001). The number of HLA-A, B, C, DR, and DQ antibodies in all patients decreased after the PAIA treatment, and the differences were statistically significant (A, B, C, DR: P<0.001, DQ: P<0.01). The humoral immune monitoring before and after the PAIA treatment showed a significant decrease in the number of IgG and complement C3 ( P<0.001 and P=0.002, respectively). Forty-four patients underwent HLA antibody monitoring after transplantation, and the overall MFI and number of antibody types decreased. However, five patients developed new antibodies with low MFI, and nine patients continued to have high MFI. The overall survival, disease-free survival, non-recurrent mortality, and cumulative recurrence rates at 100 days post-transplantation were 83.8%, 80.2%, 16.1%, and 4.5%, respectively. Conclusions:The combination of PAIA and RTX has a certain therapeutic effect and good safety in the desensitization treatment of highly sensitive patients before haplo-HSCT.
