Journal Article

Rituximab for desensitization during HLA-mismatched stem cell transplantation in patients with a positive donor-specific anti-HLA antibody

Ming-Rui, Huo, Yu-Qian, Sun, Wang, Yu, Xiao-Jun, Huang, Ying-Jun, Chang, Xiao-Hui, Zhang, Lan-Ping, Xu, Chen-Hua, Yan, Xiao-Dong, Mo, Han, Wei, Feng-Rong, Wang, Yu-Hong, Chen, Xiang-Yu, Zhao, Kai-Yan, Liu, Chen, Huan, Tang, Fei-Fei

2020

Overview

To define the efficacy of a single dose of 375 mg/m2 rituximab for DSA-positive patients with 2000 ≤ MFI < 10,000, we enrolled a prospective clinical cohort including patients with positive DSA treated with rituximab (n = 55, cohort A), a matched-pair cohort including cases with negative DSA (n = 110, cohort B) and a historical cohort including subjects with 2000 ≤ MFI < 10,000 without receiving any treatment for DSA (n = 22, cohort C). The incidences of primary poor graft function (PGF) in cohort A and cohort B were 5% and 1% (P = 0.076), respectively, both of which were lower than that in cohort C (27%, P < 0.001, for all). Rituximab was associated with a reduced incidence of primary PGF (HR 0.200, P = 0.023). The 3-year nonrelapse mortality of patients in cohort A and cohort B were 23% and 24%, respectively, both of which were lower than that in the cohort C (37%), although no statistical significance was observed. These results led to a low 3-year overall survival in patients in the cohort C (58%) compared with those in the cohort A (71%) and the cohort B (73%). We suggest that a single dose of rituximab could be effectively used to prevent the onset of primary PGF. The prospective cohort of this study is registered at http://www.chictr.org.cn/ChiCTR-OPC-15006672.

• Publisher: Nature Publishing Group
• Subject: Antibodies / Bone marrow / Desensitization / Histocompatibility antigen HLA / Immunotherapy / Monoclonal antibodies / Patients / Rituximab / Stem cell transplantation / Stem cells / Transplantation