血浆置换联合抗B细胞治疗药物应用于造血干细胞移植DSA阳性患者中的效果观察  

Clinical Application of Plasma Exchange in Desensitization Therapy for DSA Positive Patients Undergoing Hematopoietic Stem Cell Transplantation

作　　者：张媛媛[1] 王慧茹 应美爱 潘健[1] 刘磊[1] 刘会兰 ZHANG Yuanyuan;WANG Huiru;YING Meiai;PAN Jian;LIU Lei;LIU Huilan(Department of Blood Transfusion,First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),Hefei,Anhui 230001;Department of Hematology,First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),Hefei,Anhui 230001)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)输血科,安徽合肥230001 [2]中国科学技术大学附属第一医院(安徽省立医院)血液内科,安徽合肥230001

出　　处：《临床输血与检验》2025年第2期156-162,共7页Journal of Clinical Transfusion and Laboratory Medicine

基　　金：科大新医学培育项目(No.YD9110002033)资助。

摘　　要：目的观察血浆置换在造血干细胞移植供者特异性HLA抗体(DSA)阳性患者脱敏治疗中的临床应用效果。方法回顾分析2021年7月—2023年7月本院30例行血浆置换联合抗B细胞治疗方案脱敏的DSA阳性患者,观察血浆置换治疗前后DSA平均荧光强度值的变化对移植过程中细胞植入和移植后GVHD发生率的影响,分析血浆置换治疗过程中不良反应发生情况。结果30名患者共行64次血浆置换,血浆置换治疗前后DSA平均荧光强度值为7182.9±5535.3 vs 2311.8±2835.9(P<0.001)。25/30例异基因造血干细胞移植(allo-HSCT),其中非亲缘脐血移植(UCBT)19例,单倍体造血干细胞移植(haplo-HSCT)6例,23例患者(23/25,92%)实现了造血重建,中性粒细胞和血小板中位植入时间分别为14(9~60)天和31(10~64)天。两例患者植入失败行二次移植。5例患者未移植或数据删失。23例患者移植后30天内Ⅱ~ⅣaGVHD的累积发生率为41%。血浆置换过程中共发生24次轻度低钙和过敏不良反应,经处理后缓解,不影响执行。结论血浆置换联合抗B细胞治疗是造血干细胞移植DSA阳性患者脱敏治疗的有效方法,增加了HLA抗体阳性患者的移植机会。Objective To observe the clinical efficacy of plasma exchange in desensitization treatment of DSA(donorspecific antibody)positive patients undergoing hematopoietic stem cell transplantation(HSCT).Methods A retrospective analysis was carried out of 30 DSA positive patients desensitized with plasma exchange and combined with anti-B cell therapy in our hospital from July 2021 to July 2023.We primarily investigated the changes in the average fluorescence intensity of DSA before and after plasma exchange therapy,its impact on the incidence of cell implantation during transplantation and GVHD(graft-versus-host disease)after transplantation,and the adverse reactions during plasma exchange therapy.Results Totally 64 plasma exchanges were performed on 30 patients,with 24 mild adverse reactions including hypocalcemia and allergies.These reactions were relieved after treatment and did not didrupt the plasma exchange process.The average fluorescence intensity of DSA before and after plasma exchange was 7182.9±5535.3 and 2311.8±2835.9,respectively(P<0.001).Among the 30 patients,25 underwent allo-HSCT(umbilical cord blood transplantation in 19 and Haplo HSCT in 6),with 23(92%)achieving hematopoietic reconstruction.The median engraftment times were 14(9~60)days for neutrophils and and 31(10~64)days for platelets.Two patients underwent secondary transplantation due to failed engraftment.Five patients were not transplanted or their data was deleted.The cumulative incidence ofⅡ~ⅣaGVHD within 30 days after transplantation in 23 patients was 41%.Conclusion Plasma exchange combined with anti B cell therapy is an effective desensitization therapy for DSA positive patients subjected to hematopoietic stem cell transplantation.

关 键 词：造血干细胞移植 供者特异性HLA抗体 血浆置换 

分 类 号：R457[医药卫生—治疗学]