关于对具有捐赠者特异性抗HLA抗体的患者的检测和治疗的ASTCT共识建议
Piyanuch Kongtim1, Pongthep Vittayawacharin1, Jun Zou2
1Hematopoietic Stem Cell Transplant and Cellular Therapy Program, Division of Hematology and Oncology, Department of Medicine, Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, CA, USA.
Transplantation and cellular therapy
|September 11, 2024
概括
捐赠者特异性抗HLA抗体 (DSA) 在全源造血干细胞移植 (HSCT) 中可能导致移植失败. 适度至高DSA水平的脱敏疗法改善了移植和生存结果.
科学领域:
- 免疫学 免疫学 免疫学
- 移植医学 移植医学
- 血液学 血液学 血液学
背景情况:
- 捐赠者特异性抗HLA抗体 (DSA) 是所有原血型造血干细胞移植 (HSCT) 中移植失败和生存率低下的重要危险因素.
- DSA检测方法,包括多重珠数组,流量细胞计交叉匹配和C1q测试,在灵敏度和临床相关性方面各不相同.
- DSA的发病率和临床影响受到患者因素,检测技术和确定的值的影响.
研究的目的:
- 为了标准化基于证据的实践,用于管理DSA在异种HSCT.
- 审查当前的脱敏疗法及其在缓解DSA和改善移植方面的有效性.
- 确定未来的研究方向,以优化DSA相关并发症的治疗策略.
主要方法:
- 审查现有的文学和多中心的经验,在HSCTDSA检测和管理的现有文学和多中心的经验.
- 对脱敏方案的分析,包括血交换,rituximab和静脉注射免疫球蛋白.
- 评估HSCT前后的DSA监测策略,以指导预防性治疗.
主要成果:
- 患有中度至高DSA水平的患者从脱敏疗法中受益,实现与DSA阴性接受者相比的移植率.
- 低DSA水平 (<2,000 MFI) 可能不需要治疗,而非常高的水平 (>20,000 MFI) 则表明移植失败的高风险.
- 根据DSA水平和交叉匹配结果量身定制的多模式脱敏方案,有效降低抗体水平并改善结果.
结论:
- 脱敏疗法对于管理异性HSCT中的DSA至关重要,改善了移植接受和患者存活率.
- 需要标准化方案和进一步的前性研究来优化DSA的治疗策略.
- 有效地管理DSA可以减轻HSCT的严重并发症,提高HLA不匹配移植的成功率.
关键词:
提供者特定的抗HLA抗体.全基因干细胞移植移植.带血移植 移植 带血移植移植失败是因为移植失败.半同源干细胞移植手术不匹配的不相关的捐赠者移植.糟糕的移植功能 移植功能不佳治疗指南 治疗指南与治疗相关的死亡率.更多相关视频
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