增加强度预处理单倍体造血干细胞移植治疗10例HLA供者特异性抗体（DSA）强阳性血液病患者临床观察

OBJECTIVE: To explore the efficacy of immunosuppression intensified conditioning regimen in patients who have strongly positive donor-specific Anti-HLA antibodies（DSAs）and received a haploidentical hematopoietic stem cell transplantation（haplo-HSCT）. METHODS: Clinical data of 10 patients with strongly positive pretransplant DSAs（defined as MFI ≥10000）were retrospectively analyzed in this study. All of them received a haplo-HSCT in the Hematology Department of Shanghai Zhaxin Traditional Chinese & Western Medicine Hospital. RESULTS: ① Of all ten patients, three were males, and seven were females, with a median age of 53.5（36−64）years. Of the 10 patients, three were diagnosed with acute myeloid leukemia, two were myelodysplastic syndromes（MDS）, two were chronic myelomonocytic leukemia（CMML）, two were in an accelerated phase of chronic myeloid leukemia（CML-AP）, and one was primary myelofibrosis（PMF）. ② Conditioning regimen consisted of fludarabine（Flu）/busulfan（Bu）combined with whole-body irradiation（TBI）/cyclophosphamide（Cy）. ③ On the seventh day after transplantation, the median pretransplant DSA level was MFI 15 999（10 210−23 417）and 10 787（0−22 720）. ④ Eight patients acquired hematopoietic reconstitution; the median time of neutrophil engraftment was 14（10−16）days; and 18（14−20）days for platelet engraftment. After a median follow-up of 12.5（1.5−27）months, primary graft failure was found in one patient and another with poor graft function. Seven patients remained in a disease remission state, and all were DSA-negative. CONCLUSION: An intensified immunosuppression conditioning regimen can efficiently decrease the level of donor-specific anti-HLA antibodies（DSAs）, leading to good short-term efficacy.