title: Desensitization with plasma exchange in a patient with human leukocyte antigen donor-specific antibodies before T-cell-replete haploidentical transplantation.
abstract: BACKGROUND
  The presence of human leukocyte antigen donor-specific antibodies (DSAs) increases the risk of graft failure in T-cell-replete haploidentical hematopoietic stem cell transplantation (haplo-HSCT) CASE REPORT: A 49-year-old female with high-risk acute myeloid leukemia in first complete remission received a haplo-HSCT from her daughter. Pretransplant recipient screening examination showed high DSAs levels against unshared class I leukocyte antigens.
  
  
  RESULTS
  The patient underwent a desensitization program consisting of plasma exchange (PEX), polyvalent intravenous (IV) immunoglobulins, and IV tacrolimus and mycophenolate mofetil (MMF). This protocol resulted in the disappearance of the DSA anti HLA B41. Engraftment was prompt with stable full donor chimerism.
  
  
  CONCLUSIONS
  This case report suggests that the adopted scheme is safe for reducing DSA levels and facilitating donor engraftment in patients scheduled for haplo-HSCT.
authors.affiliation: Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Bramanti
authors.affiliation: Immuno-Hematology Laboratory, IRCCS Ospedale Maggiore, Milano, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Nocco
authors.affiliation: Transplant Unit Ospedale Ferrarotto, Catania, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Mauro
authors.affiliation: Transplant Unit Ospedale Ferrarotto, Catania, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Milone
authors.affiliation: Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy.
authors.forename: Lucio
authors.initials: L
authors.lastname: Morabito
authors.affiliation: Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Sarina
authors.affiliation: Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Crocchiolo
authors.affiliation: Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy.
authors.forename: Inna
authors.initials: I
authors.lastname: Timofeeva
authors.affiliation: Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy.
authors.forename: Rossana
authors.initials: R
authors.lastname: Capizzuto
authors.affiliation: Hematology Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Carlo-Stella
authors.affiliation: Hematology Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy.
authors.forename: Armando
authors.initials: A
authors.lastname: Santoro
authors.affiliation: Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Castagna