Evidence map›Paper›PMID 33899963›Full record

ArticleTransfusion2021

Rebound and overshoot of donor-specific antibodies to human leukocyte antigens (HLA) during desensitization with plasma exchanges in hematopoietic progenitor cell transplantation: A case report.

Sajjad Hassan, Kamille A West, William W Ward, Jennifer A Kanakry, Willy A Flegel

Open access · greenAbstract readCase Reports
PubMed Full text at PMC Publisher
In one paragraph

Article in Transfusion, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
1.2field-weighted citation impact, top 22% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it, 10 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Article
  4. Article
  5. Article
  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 1 institution in 1 country.

Sajjad HassanDepartment of Transfusion Medicine, NIH Clinical Center, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.ORCID 0000-0002-7264-5989
Kamille A WestDepartment of Transfusion Medicine, NIH Clinical Center, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
William W WardDepartment of Transfusion Medicine, NIH Clinical Center, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
Jennifer A KanakryExperimental Transplantation and Immunotherapy Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
Willy A FlegelDepartment of Transfusion Medicine, NIH Clinical Center, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.ORCID 0000-0002-1631-7198
National Institutes of Health · US

Funding

Laboratory Services Section, Department of Transfusion Medicine Core ReportZICCL002128 · CLC · CLINICAL CENTER · PI FLEGEL, WILLY · 2020 to 2025
$0k
Intramural NIH HHS ZIC CL002128NIH Clinical Center
6 · The paper itself

Abstract

backgroundDonor-specific antibodies (DSA) to HLA have been associated with graft loss in hematopoietic progenitor cell (HPC) transplantation. Limited data associate therapeutic plasma exchange (TPE) with desensitization and successful engraftment. We report an attempt of desensitization and observed overshooting of DSA during transplantation. CASE REPORT AND

resultsA 27-year-old female with cutaneous T cell lymphoma was scheduled for HPC transplantation from her HLA-haploidentical half-sister, who carried the HLA-DRB1*13:03:01 allele. The patient had the corresponding DSA. Lacking an alternative donor option at the time, we attempted a desensitization approach by immunosuppression with tacrolimus and mycophenolate mofetil (MMF). Unexpectedly, DSA increased from a mean fluorescence intensity (MFI) of 1835 on day -63 to 9008 on day -7. The MFI increased further during 3 TPE procedures and intravenous immunoglobulin (IVIG) until day -1. After transplantation, the DSA remained elevated despite 2 more TPE/IVIG procedures and graft-versus-host disease prophylaxis with high-dose cyclophosphamide, sirolimus, and MMF. Flow cytometric crossmatch, initially negative, turned positive after transplantation. Primary graft failure occurred and was attributed to antibody-mediated rejection. A second transplantation from a 7/8 HLA-matched unrelated donor, not carrying DRB1*13:03 allele, resulted in successful engraftment.

conclusionUnexpected and rapid increases of a DSA can occur despite the use of current desensitization approaches. This is problematic when conditioning has already started, as such increases are unlikely to be overcome by TPE or other interventions for desensitization. Overshoot of DSA in HPC transplantation has rarely been reported. Its cause remains unclear and can include underlying disease, immunotherapy, chemotherapy, or TPE.

Indexed as

Hematopoietic Stem Cell TransplantationPlasma ExchangeAdultAntibodiesFemaleHLA AntigensHumansImmunosuppression TherapyLymphoma, T-Cell, CutaneousTissue DonorsAntibodiesHLA Antigensdonor-specific antibodieshematopoietic progenitor cellsHLA antibodiesplasmapheresistransplantation

Identifiers

PMID33899963
PMCPMC9097367
OpenAlexW3158493032

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.