Conclusions
An intensified immunosuppression conditioning regimen can efficiently decrease the level of donor-specific anti-HLA antibodies (DSAs), leading to good short-term efficacy. 目的： 探讨增加强度预处理单倍体造血干细胞移植（haplo-HSCT）对于HLA供者特异性抗体（DSA）强阳性血液病患者的疗效。 方法： 纳入2019年5月1日至2022年9月1日在上海闸新中西医结合医院血液科接受增加强度预处理haplo-HSCT的DSA平均荧光强度（MFI值）≥10 000的10例血液病患者，对其临床资料进行回顾性分析。 结果： ①10例患者中男3例、女7例，中位年龄为53.5（36~64）岁；急性髓系白血病（AML） 3例，骨髓增生异常综合征（MDS）2例，慢性粒-单核细胞白血病（CMML）2例，慢性髓性白血病加速期（CML-AP）2例，原发性骨髓纤维化（PMF）1例。②接受氟达拉滨（Flu）/白消安（Bu）为主联合全身放射治疗（TBI）/环磷酰胺（CTX）预处理方案。③移植前DSA中位MFI值为15 999（10 210~23 417），移植后第7天DSA中位MFI值为10 787（0~22 720）。④8例患者获得粒细胞和血小板植入，中位粒细胞植入时间为14（10~16）d，中位血小板植入时间为18（14~20）d。中位随访12.5（1.5~27）个月，原发植入失败、移植物植入功能不良患者各1例，7例患者DSA转为阴性且处于无进展生存状态。 结论： 增加强度预处理haplo-HSCT能够有效降低DSA强阳性血液病患者DSA强度，获得较好的近期疗效。.
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.
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) .
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. Conclusions: An intensified immunosuppression conditioning regimen can efficiently decrease the level of donor-specific anti-HLA antibodies (DSAs), leading to good short-term efficacy. 目的： 探讨增加强度预处理单倍体造血干细胞移植（haplo-HSCT）对于HLA供者特异性抗体（DSA）强阳性血液病患者的疗效。 方法： 纳入2019年5月1日至2022年9月1日在上海闸新中西医结合医院血液科接受增加强度预处理haplo-HSCT的DSA平均荧光强度（MFI值）≥10 000的10例血液病患者，对其临床资料进行回顾性分析。 结果： ①10例患者中男3例、女7例，中位年龄为53.5（36~64）岁；急性髓系白血病（AML） 3例，骨髓增生异常综合征（MDS）2例，慢性粒-单核细胞白血病（CMML）2例，慢性髓性白血病加速期（CML-AP）2例，原发性骨髓纤维化（PMF）1例。②接受氟达拉滨（Flu）/白消安（Bu）为主联合全身放射治疗（TBI）/环磷酰胺（CTX）预处理方案。③移植前DSA中位MFI值为15 999（10 210~23 417），移植后第7天DSA中位MFI值为10 787（0~22 720）。④8例患者获得粒细胞和血小板植入，中位粒细胞植入时间为14（10~16）d，中位血小板植入时间为18（14~20）d。中位随访12.5（1.5~27）个月，原发植入失败、移植物植入功能不良患者各1例，7例患者DSA转为阴性且处于无进展生存状态。 结论： 增加强度预处理haplo-HSCT能够有效降低DSA强阳性血液病患者DSA强度，获得较好的近期疗效。.