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Donor‐specific HLA antibody (DSA) has been recognised as an independent risk factor for graft failure in patients undergoing haploidentical haematopoietic stem cell transplantation (HID HSCT). Therapeutic plasma exchange (TPE), as a first‐line strategy for DSA desensitisation, can promptly reduce serum DSA levels. This study aimed to investigate DSA characteristics and identify a biomarker predicting the efficacy of DSA desensitisation in patients proceeding to HID HSCT. We retrospectively enrolled 32 patients with DSA from April 2021 to January 2024, and analysed the mean fluorescence intensity (MFI) value of DSA at the different time points of desensitisation treatment. Compared with baseline DSA level before TPE, the median MFI of HLA class I DSA was reduced from 8178.6 to 795.3 ( p 70%), partial responders (decreased by 30 to 70%) and non‐responders (decreased by <30%) and the percentages were 43.8%, 25% and 31.2%, respectively. Non‐responders receiving aggressive immunotherapy had longer overall survival compared to those receiving standard strategies ( p < 0.05). The 1:16 diluted pre‐TPE serum may predict the efficacy of TPE and allow for more rational immunotherapy strategy for patients with DSA proceeding to HID HSCT.
Li et al. (2024) studied this question.