AM24-ST-01-O: The Use of HLA-Typed Cellular Transfusions and/or Infusions for In Vivo Adsorption of Donor-Specific HLA Antibodies (DSAs) as a Desensitization Strategy for Hematopoietic Stem Cell Transplant Patients (Enduring)

CABP CE Eligible 

Not every hematopoietic stem cell transplant (HSCT) patient will be able to find a 10/10 HLA-matched donor, much less the perfect 12/12 matched donor. In these situations, one can turn to the availability of HLA-mismatched stem cell donors, which include haploidentical related donors, mismatched unrelated donors, and mismatched cord blood stem cells. Over time, we have seen increasing advancements in clinical practice that have moved needle in the direction of equivalent or non-inferior outcomes with mismatched stem cell donor options. The downside of seeing this increasing use of HLA-mismatched donors is that we are also encountering with greater frequency the challenge of donor specific HLA-antibodies (DSAs) in the patient, which put the patient at increased risk for delayed engraftment or even engraftment failure, especially when DSAs are present at high titers. Therefore, there is an ongoing exploration of different desensitization strategies targeted at reducing DSAs to clinically useful levels. These include various approaches directed towards decreasing antibody production and removing DSAs already in circulation, and are often used in combination. One strategy that has emerged, and which is relevant to the transfusion medicine community but not yet well known, is the modality of using HLA-typed platelet and/or leukocyte transfusions/infusions to remove DSAs via “in vivo adsorption”. In this session, Dr. Deanna Fang will first present the HLA-related principles behind this technique and provide a review the evidence presented internationally in literature thus far. Then, Dr. Stefan Ciurea, the director of his institution's Hematopoietic Stem Cell Transplantation and Cellular Therapy Program, will present on his experience with the first known United States-based published and protocolized practice of incorporating HLA-typed cellular infusions as part of an HSCT patient's desensitization regimen. Dr. Minh-Ha Tran will also be present to share his expertise with this protocol from the transfusion medicine physician's perspective with regards to the logistics of donor collection and product processing and issuance.