供者特异性HLA抗体及去敏治疗对单倍体造血干细胞移植植入效果的影响

马遥; 张艳芳; 周慷; 罗云; 陈姝; 娄世锋; 邓建川

doi:10.16016/j.2097-0927.202309072

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供者特异性HLA抗体及去敏治疗对单倍体造血干细胞移植植入效果的影响

专题报道：血液肿瘤诊治前沿 | 更新时间：2026-01-09

- 供者特异性HLA抗体及去敏治疗对单倍体造血干细胞移植植入效果的影响
- Effects of anti-HLA donor-specific antibodies and desensitization on engraftment of haploidentical hematopoietic stem cell transplantation
- 陆军军医大学学报 2024年46卷第4期页码：319-325
- 作者机构：
  
  400010 重庆，重庆医科大学附属第二医院血液内科
- 作者简介：
  
  [邓建川，E-mail: dengjccq@hospital.cqmu.edu.cnDENG Jianchuan, E-mail: dengjccq@hospital.cqmu.edu.cn
- 基金信息：
- DOI：10.16016/j.2097-0927.202309072
  中图分类号： R392.4;R617;R733.7
- 收稿：2023-09-13，
  
  修回：2023-12-22，
  
  纸质出版：2024-02-28
- 稿件说明：
移动端阅览
马遥, 张艳芳, 周慷, 等. 供者特异性HLA抗体及去敏治疗对单倍体造血干细胞移植植入效果的影响[J]. 陆军军医大学学报, 2024,46(4):319-325.

Yao MA, Yanfang ZHANG, Kang ZHOU, et al. Effects of anti-HLA donor-specific antibodies and desensitization on engraftment of haploidentical hematopoietic stem cell transplantation[J]. Journal of Army Medical University, 2024, 46(4): 319-325.
马遥, 张艳芳, 周慷, 等. 供者特异性HLA抗体及去敏治疗对单倍体造血干细胞移植植入效果的影响[J]. 陆军军医大学学报, 2024,46(4):319-325. DOI： 10.16016/j.2097-0927.202309072.

Yao MA, Yanfang ZHANG, Kang ZHOU, et al. Effects of anti-HLA donor-specific antibodies and desensitization on engraftment of haploidentical hematopoietic stem cell transplantation[J]. Journal of Army Medical University, 2024, 46(4): 319-325. DOI： 10.16016/j.2097-0927.202309072.

摘要

目的

分析供者特异性HLA抗体(anti-HLA donor-specific antibodies

DSA)及DSA阳性患者的去敏治疗对单倍体造血干细胞移植(haploidentical hematopoietic stem cell transplantation

haplo-HSCT)植入效果的影响。

方法

收集2017年3月至2023年7月重庆医科大学附属第二医院血液内科行haplo-HSCT

并完成HLA抗体及DSA检测的患者70例

分析DSA阳性和DSA阳性患者去敏治疗对造血干细胞移植植入效果的影响。

结果

70例haplo-HSCT患者完成抗体检测

DSA阳性患者15例(21.4%)

其中7例(46.7%)强阳性

3例(20.0%)中度阳性

5例(33.3%)弱阳性。DSA阳性患者移植后粒系植入中位时间较DSA阴性患者明显延迟(

=0.027)。植入失败(graft failure

GF)患者6例

DSA阳性4例(26.7%)

明显高于DSA阴性(

=0.025)。多因素分析结果显示

DSA是发生GF的独立影响因素(

=9.273

95%

=1.505~57.124

=0.016)。10例DSA中度和强阳性患者进行去敏治疗

4例采用联合去敏治疗

患者均成功植入(100.0%)

6例采用单一去敏治疗

有4例(66.7%)发生GF

联合去敏治疗的GF发生率显著低于单一去敏治疗(

=0.008)。

结论

DSA是导致haplo-HSCT患者植入延迟和GF的重要因素

对DSA中度及强阳性患者的单一去敏治疗效果有限

而多联合的去敏治疗时

动态监测抗体滴度水平下降

可保证干细胞的成功植入

降低GF发生。

Abstract

Objective

To investigate the effects of anti-HLA donor-specific antibodies (DSA) and desensitization for DSA+patients on engraftment of haploidentical hematopoietic stem cell transplantation (haplo-HSCT).

Methods

The patients who underwent haplo-HSCT and examinations for HLA antibodies and DSA in our department from March 2017 to July 2023 were recruited in this study.The effects of desensitization measure on engraftment in the DSA+patients after haplo-HSCT were analyzed.

Results

Among the 70 patients who underwent haplo-HSCT and test for HLA antibodies

15(21.4%) patients were DSA positive

including 7(46.7%) cases of strong positive

3(20.0%) cases of moderate positive

and 5(33.3%) cases of weak positive.The median duration for neutrophil implantation was significantly extended in the DSA+patients than the negative patients (

=0.027).For the 6 patients developed graft failure (GF)

4 were DSA+which was statistically higher than the DSA-patients (

=0.025).Multivariate regression analysis showed that DSA was an independent factor affecting GF (

=9.273

95%

: 1.505~57.124

=0.016).Among the 10 patients (7 strong positive and 3 moderate positive DSA) received desensitization therapy

4 patients received combination desensitization

with a 100% rate of successful transplantation

and 6 received single desensitization

with 4(66.7%) experiencing GF

so the GF rate was obviously lower in the combination than the single desensitization (

=0.008).

Conclusion

In haplo-HSCT patients

DSA is an important factor leading to implantation delay and GF.While

single desensitization treatment has limited efficacy.In combined DSA desensitization therapy

the decrease of antibody titer should be dynamically monitored to ensure the successful implantation of stem cells and reduce GF rate.

关键词

Keywords

references

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