二次单倍体造血干细胞移植治疗初次移植后新生DSA致原发性植入失败1例报道并文献复习

A Case Report and Literature Review:Second Transplantation for Primary Graft Failure of Haploidentical Hematopoietic Stem Cell Transplantation Due to Newly Generated Donor-Specific Antibodies

目的结合文献总结单倍体造血干细胞移植(haplo-HSCT)后因新生供体特异性抗体(DSA)产生导致原发植入失败,再次行二次移植并获得成功的罕见病例的诊疗经验。方法回顾性分析1例难治性急性髓系白血病,行两次子供母haplo-HSCT的临床资料,并复习相关文献。结果患者接受第一次子供母haplo-HSCT,因移植后产生DSA,导致原发性植入失败,给予血浆置换、抗CD20单抗等清除抗体治疗,待DSA滴度下降后行同一供体的二次移植,术后患者血象恢复正常,至今无病存活。结论造血干细胞移植后新生DSA,是导致haplo-HSCT后原发性植入失败的原因之一,移植前后多次进行DSA的监测和处理是预防和治疗植入失败的有效途径。

Objective To explore the diagnosis and treatment for graft failure of haploidentical hematopoietic stem cell transplantation(haplo-HSCT)due to newly generated donor-specific-antibodies(DSA).Methods A case of refractory acute myeloid leukemia who underwent second haplo-HSCT was retrospectively analyzed and relative literatures were reviewed.Result The patient developed primary graft failure after the first haplo-HSCT because of strongly newly DSA level.She received desensitization treatment including plasmapheresis and antiCD20 monoclonal antibody.The MFI level of DSA was decreased after therapy.Second haploidentical transplant was performed and hematopoietic recovered successfully.Conclusion Newly generated DSA after haplo-HSCT is rare,which may lead to graft failure.It is necessary to monitor DSA before and after transplant dynamically.