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The use of posttransplant cyclophosphamide has revolutionized the field of haploidentical hematopoietic stem cell transplant. The impact has been especially enhanced in low- and middle-income countries. Unrelated donor pool in developing nations is often limited due to the lack of large unrelated donor registries. Donor-specific antibodies (DSAs) are preformed immunoglobulin G anti-human leukocyte antigen (HLA) antibodies against HLA antigens that are not shared with the donor. We present successful desensitization in a 13-year-old patient with class III β-thalassemia with very high MFI DSAs with flow crossmatch positivity, persisting after pretransplant immunosuppression.
Kapoor et al. (Mon,) studied this question.