Successful Allogeneic Hematopoietic Stem Cell Transplantation From A 5/10 Mismatched Unrelated Donor in A Patient With Donor-specific Anti-hla Antibodies. - Successful Allogeneic Hematopoietic Stem Cell Transplantation From A 5/10 Mismatched Unrelated Donor in A Patient With Donor-specific Anti-hla Antibodies. - Open Access Pub

Hematopoietic stem cell transplantation (HSCT) from a mismatched unrelated donor, an haploidentical donor or a cord blood unit (CBU) has become a widely aviable approach if patient lacks a matched related or unrelated donor. However, if the patient has anti-HLA antibodies against antigens present in the mismatched donor or CBU (donor-specific antibodies, DSAs) this option should be disregarded due to the high risk of graft failure. Desensitization can be used to reduce levels of DSAs but this technique has limited results. We report the case of a 62-year-old woman with DSAs against two haploidentical familiar donors who failed desensitization of DSAs. Finally she underwent a HSCT from a 5/10 mismatched unrelated donor which has been successful. DOI 10.14302/issn.2372-6601.jhor-18-1988 Currently, for patients requiring hematopoietic stem cell transplantation (HSCT) but lacking a matched related or a matched unrelated donor (MUD) (20%) an HSTC from a mismatched unrelated donor (mMUD), a cord blood unit (CBU) or an HLA-haploidentical HSCT (haplo-HSCT) represent a widely available approach. Several studies show that high dose cyclophosphamide administered after HCT (PTCy) is a feasible option for haploidentical and mismatched in terms of safety profile and low rates of graft versus host disease (GVHD) and transplant non-related mortality (NRM) 1,2 HLA antibodies should be examined as part of the pre-transplant work-up, especially in transplants with HLA-mismatches planned for parous women and multi-transfused receptors. Furthermore, donors who have HLA antigens that correspond to high levels of donor-specific anti-HLA antibodies (DSAs) in the patient should be avoided. DSAs are considered positive when median fluorescence intensity (MFI) is > 3000 -5000 and > 10.000 as very high levels corresponding to the mismatched donor HLA antigen3,4 Thus, if the patient has donor-specific anti-HLA antibodies against antigens present in the mismatched donor or CBU, this option should be disregarded due to the high risk of graft failure (GF)3,5,6. The risk of GF in the presence of DSAs is approximately 70% after T-cell replete and T-cell deplete haplo-HSCT and after CBU transplants. Similarly, after mMUD transplant the risk is between 11 to 22% 3,5,6,7 In an attempt to reduce DSAs, desensitization can be used but if levels of DSAs are high, this technique has limited results 4,3,8 A 62-year-old woman with a high-risk acute myeloid leukemia (high ratio FLT-ITD mutation and NPM1 mutation) was diagnosed on December 2016. The patient weighed 58 Kg and had a history of one