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Targeting CD38 to reduce anti-HLA antibody levels: A new and effective option to be integrated into desensitization
Viola Chiavetta1, Martina Soldarini1, Anna Maria Cafro1
1ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Desensitization protocols are employed in patients with antibody-mediated organ rejection or hematopoietic stem cell (HSC) transplant recipients from ´HLA-mismatched´ donors with donor-specific antibodies (DSA). However, these protocols sometimes have limitations in effectively reducing anti-HLA antibody levels and maintaining this reduction over time. As a result, there is an ongoing search for new, effective therapies to implement current protocols, involving anti-CD20, bortezomib, and plasma exchange. This case report explores the impact of daratumumab, a well-known anti-CD38 antibody used in the treatment of multiple myeloma, on a patient enrolled in a prospective observational study MyTH ("(My)eloma (T)herapy vs. Anti-(H)LA antibodies"). The patient has been treated since 2021 and follow-up data are presented here, showing a correlation between the kinetics of daratumumab administration and the MFI levels of an anti-HLA antibody against DR12 (baseline MFI of 3,890). These data support the role of anti-CD38 in reducing anti-HLA antibody synthesis.
Desensitization protocols are employed in patients with antibody-mediated organ rejection or hematopoietic stem cell (HSC) transplant recipients from ´HLA-mismatched´ donors with donor-specific antibodies (DSA). However, these protocols sometimes have limitations in effectively reducing anti-HLA antibody levels and maintaining this reduction over time. As a result, there is an ongoing search for new, effective therapies to implement current protocols, involving anti-CD20, bortezomib, and plasma exchange. This case report explores the impact of daratumumab, a well-known anti-CD38 antibody used in the treatment of multiple myeloma, on a patient enrolled in a prospective observational study MyTH ("(My)eloma (T)herapy vs. Anti-(H)LA antibodies"). The patient has been treated since 2021 and follow-up data are presented here, showing a correlation between the kinetics of daratumumab administration and the MFI levels of an anti-HLA antibody against DR12 (baseline MFI of 3,890). These data support the role of anti-CD38 in reducing anti-HLA antibody synthesis.
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