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Case Report
Salvage Transplantation with Cord Blood for Graft Rejection of Peripheral Blood Stem Cells due to Donor Specific Antibody
Maria Regina Pelobello de Leon1,2, Shuichiro Takahashi1,3, Masahiro Onozawa1, Makoto Ito4, Manabu Nakano5, Hajime Senjo1, Masahiro Chiba1, Hiroyuki Ohigashi1, Emi Yokoyama1, Junichi Sugita1, Daigo Hashimoto1, Takanori Teshima1

1Department of Hematology, Faculty of Medicine, Hokkaido University, Sapporo, Japan,

2Department of Medicine, Section of Hematology, Makati Medical Center, Makati City, Phillippines,

3Sapporo Hokuyu Hospital, Sapporo, Japan,

4Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan,

5Japanese Red Cross Hokkaido Block Blood Center, Sapporo, Japan

Keywords
haploidentical transplantation, graft rejection, donor specific antibody, posttransplantation cyclophosphamide, cord blood transplantation
Submitted:May 18, 2020
Accepted:June 26, 2020
Published online:August 31, 2020

Abstract

Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative therapy for various kinds of hematological malignancies and disorders. Recently, HLA-haploidentical stem cell transplantation with post-transplantation cyclophosphamide (PTCy-haplo HSCT) has been widely performed due to its safety and favorable immune recovery. However, graft rejection remains an obstacle to PTCy-haplo HSCT. Donor specific antibody (DSA) is considered to be a major factor of graft rejection of haplo HSCT. We herein present a case of graft rejection after PTCy haplo-HSCT due to DSA induced by pretransplant platelet transfusion after donor selection. The patient was dependent on platelet transfusion and had not received cytotoxic chemotherapy because he was diagnosed as myelodysplastic syndrome/myeloproliferative neoplasm-unclassifiable. We retrospectively confirmed the level of DSA just before the first transplantation and found that it was dramatically elevated, which was enough to cause graft rejection. We successfully performed cord blood transplantation of the HLA that was not the target of DSA, as salvage transplantation without any desensitization. This case illustrates that we have to confirm the presence of DSA immediately before the haplo-HSCT, particularly in high risk patients who are dependent on platelet transfusion and have no cytotoxic chemotherapy before HSCT.

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Online ISSN:2432-7026