Abstract: Objective To investigate and analyze the efficacy of dual-membrane filtration plasma exchange (DFPP) combined with desensitization therapy in the treatment of donor-specific antibodies (DSA) in haploid matched hematopoietic stem cell transplantation patients.  Methods  The DSA-positive patients were desensitized with DFPP, intravenous immunoglobulin (IVIG) and rituximab. The DSA levels before and after transplantation were measured. The incidence of implantation and graft-versus-host disease (GVHD) were evaluated and analyzed.  Results  Seven of the eight DSA patients received stable implantation of donor cells with the chimerism rate of 100%, and one patient had poor platelet implantation. After desensitization with DFPP, IVIG and rituximab, the mean fluorescence intensity (MFI) reduced to 3911±2499 (t=2.101, P＜0.000); 3 of the 8 patients turned to be weak positive. The MFI reduced further to 907±997 after stem cell reinfusion for 3 days, significantly lower than that before stem cell reinfusion (t=2.145, P=0.002). Only one of the 8 patients developed severe acute GVHD.  Conclusion Dual-membrane filtration plasma exchange combined with the desensitization therapy of high dose IVIG and rituximab can reduce the level of DSA and promote the implantation of donor stem cells.

Key words: Double membrane filtration plasma exchange, Donor-specific antibody, Haplo-identical hematopoietic stem cell transplantation