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

• Published in: Bone marrow transplantation (Basingstoke) Vol. 55; no. 7; pp. 1326 - 1336
• Main Authors: Chang, Ying-Jun, Xu, Lan-Ping, Wang, Yu, Zhang, Xiao-Hui, Chen, Huan, Chen, Yu-Hong, Wang, Feng-Rong, Han, Wei, Sun, Yu-Qian, Yan, Chen-Hua, Tang, Fei-Fei, Huo, Ming-Rui, Zhao, Xiang-Yu, Mo, Xiao-Dong, Liu, Kai-Yan, Huang, Xiao-Jun
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.07.2020; Nature Publishing Group
• Subjects: 631/250/1854/2812; 631/250/1904; Antibodies; Antithymocyte globulin; Bone marrow; Cell Biology; Desensitization; Hematology; Histocompatibility antigen HLA; Immunotherapy; Internal Medicine; Medicine; Medicine & Public Health; Monoclonal antibodies; Patients; Public Health; Rituximab; Stem cell research; Stem cell transplantation; Stem Cells; Transplantation
• ISSN: 0268-3369; 1476-5365; 1476-5365
• DOI: 10.1038/s41409-020-0928-z

To define the efficacy of a single dose of 375 mg/m 2 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 .