双重膜滤过式血浆置换联合脱敏治疗单倍体相合造血干细胞移植供者特异性抗体的临床研究  

Clinical study on donor-specific antibodies in haploid matched hematopoietic stem cell transplantation treated by dual-membrane filtration plasma exchange combined with desensitization

作　　者：王增胜[1] 聂玉玲[1] 郎涛[1] 张晓燕[1] 蔺思颖 王晓敏[1] 毛敏[1] WANG Zengsheng;NIE Yu-ling;LANG Tao;ZHANG Xiao-yan;LIN Si-ying;WANG Xiao-min;MAO Min(Department of Hematology,People’s Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China)

机构地区：[1]新疆维吾尔自治区人民医院血液科,乌鲁木齐830001

出　　处：《中国血液净化》2024年第1期22-25,共4页Chinese Journal of Blood Purification

摘　　要：目的探讨分析双重膜滤过式血浆置换(double filtration plasmapheresis,DFPP)联合脱敏治疗单倍体相合造血干细胞移植供者特异性抗体(donor specific antibody,DSA)的疗效。方法采用DFPP联合丙种免疫球蛋白(intravenous immunoglobulin,IVIG)、利妥昔单抗脱敏治疗DSA阳性患者,检测移植前后DSA水平,主要评估分析其植入情况。结果8例DSA性患者7例获得供者细胞稳定植入,嵌合率均为100%,1例血小板植入不良。经过DFPP、IVIG、利妥昔单抗脱敏处理后为平均荧光强度(mean fluorescence intensity,MFI)(3911±2499),均明显降低,差异均有统计学意义(t=2.101,P<0.001),8例患者中有3例转为弱阳性。干细胞回输第3天复测MFI(907士997),较干细胞回输前再次减低,差异均有统计学意义(t=2.145,P=0.002)。8例患者仅1例发生重度急性移植物抗宿主病。结论双重膜滤过式血浆置换脱敏联合大剂量IVIG和利妥昔单抗,尽量输注高剂量的干细胞,可以降低DSA水平促进供者干细胞植入。Objective To investigate and analyze the efficacy of dual-membrane filtration plasma exchange(DFPP)combined with desensitization therapy in the treatment of donor-specific antibodies(DSA)in haploid matched hematopoietic stem cell transplantation patients.Methods The DSA-positive patients were desensitized with DFPP,intravenous immunoglobulin(IVIG)and rituximab.The DSA levels before and after transplantation were measured.The incidence of implantation and graft-versus-host disease(GVHD)were evaluated and analyzed.Results Seven of the eight DSA patients received stable implantation of donor cells with the chimerism rate of 100%,and one patient had poor platelet implantation.After desensitization with DFPP,IVIG and rituximab,the mean fluorescence intensity(MFI)reduced to 3911±2499(t=2.101,P<0.000);3 of the 8 patients turned to be weak positive.The MFI reduced further to 907±997 after stem cell reinfusion for 3 days,significantly lower than that before stem cell reinfusion(t=2.145,P=0.002).Only one of the 8 patients developed severe acute GVHD.Conclusion Dual-membrane filtration plasma exchange combined with the desensitization therapy of high dose IVIG and rituximab can reduce the level of DSA and promote the implantation of donor stem cells.

关 键 词：双重膜滤过式血浆置换 供者特异性抗体 单倍体相合造血干细胞移植 

分 类 号：R45[医药卫生—治疗学]