ArticleAnnals of hematology2026
Plasma exchange combined with anti-B-cell therapy enables comparable outcomes between DSA-positive and DSA-negative aplastic anemia after haplo-HSCT: a propensity-score-matched cohort study.
Article in Annals of hematology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the only curative treatment for aplastic anemia (AA). For patients lacking a matched sibling donor (MSD) or matched unrelated donor (MUD), haploidentical HSCT (haplo-HSCT) has become an alternative with comparable efficacy. However, donor-specific anti-HLA antibodies (DSAs) remain the principal barrier. In this study, we compared transplant outcomes in DSA-positive recipients after desensitization with plasma exchange (PE) combined with anti-B-cell therapy. Between January 2019 and December 2023, we enrolled 30 DSA-positive AA patients who underwent haplo-HSCT at our center. All received a desensitization regimen combining PE with anti-B-cell agents. By propensity-score matching (1:2 ratio, caliper 0.02), we additionally enrolled 60 DSA-negative controls matched for key clinical variables to compare therapeutic efficacy and long-term outcomes between the two groups. This study enrolled 90 AA patients who underwent haplo-HSCT: 30 were DSA-positive and 60 were DSA-negative. Baseline characteristics were comparable between the two groups. After desensitization with PE combined with anti-B-cell agents, the DSA-positive group achieved outcomes equivalent to those of the DSA-negative group. Specifically, EBV reactivation (46.7% vs. 68.3%; P = 0.002) was significantly better in the DSA-positive group. Engraftment, aGVHD, Effacacy, OS, and GRFS rates were similar between two groups. However, the risk of cGVHD remains higher in the DSA-positive group (40% vs. 12%; P = 0.009). For DSA-positive AA patients who are candidates for haplo-HSCT and for whom no DSA-negative donor can be identified, desensitization with PE combined with anti-B-cell agents represents an established strategy to improve transplant outcomes; nevertheless, close surveillance for cGVHD is warranted after transplantation.
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