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<p>Immunized platelet transfusion refractoriness (immunized-PTR) correlates with poor outcomes in hematological malignancies (HM) patients during allogeneic hematopoietic stem-cell transplantation (allo-HSCT). The efficacy and outcomes of desensitization with rituximab (RTX) and therapeutic plasma exchange (TPE) for immunized-PTR remain controversial. The study included 83 Ab-negative non-PTR patients and 65 patients with severe immunized-PTR who underwent allo-HSCT. Based on pre-transplant desensitization, 30 and 35 patients were classified into the Ab-positive PTR-treatment and Ab-positive PTR groups. After desensitization, HLA antibodies were decreased (71 ± 19 <i>vs</i>. 26 ± 22, <i>P</i> &lt;0.01), 14h-corrected count increment (CCI) was increased(14.64 ± 5.36 <i>vs</i>. 2.00 ± 1.33, <i>P</i> &lt;0.001), and the cumulative incidence of platelet engraftment at day 21 and 6 months was higher (93.3% <i>vs</i>. 82.9% in Ab-positive PTR group, <i>P</i> = 0.0002 and 90.0% <i>vs</i>. 67.1% in Ab-positive PTR group, <i>P</i> = 0.0005), significantly. Compared to Ab-positive PTR groups, desensitization leads to a better prognosis in Ab-positive PTR-treatment group (3-year OS: 93.3% <i>vs</i>. 47.0%, <i>P</i> &lt;0.0001; 3-year LFS: 83.0% <i>vs</i>. 48.0%,respectively, <i>P</i> &lt;0.0001). Multivariable analysis revealed that desensitization was independently associated with better OS (HR, 0.068; 95%CI, 0.014-340; <i>P</i> = 0.001) and LFS (HR, 0.090; 95%CI, 0.023-358; <i>P</i> = 0.001) for PTR patients. This result indicates that immunized-PTR is associated with poor outcomes in HM patients after allo-HSCT, and desensitization with RTX and TPE achieve favorable outcomes.</p>

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Treatment outcome and efficacy of desensitization strategies for immunized-PTR in hematological malignancies before hematopoietic stem cell transplantation

  • 期刊论文

  • 发表日期：

    2026年1月28日

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  • Yizhou Pan,
  • Yuanling Zuo,
  • Qingya Cui,
  • Sining Liu,
  • Haiping Dai,
  • Depei Wu,
  • Min Jiang,
  • Xiaowen Tang

摘要

Immunized platelet transfusion refractoriness (immunized-PTR) correlates with poor outcomes in hematological malignancies (HM) patients during allogeneic hematopoietic stem-cell transplantation (allo-HSCT). The efficacy and outcomes of desensitization with rituximab (RTX) and therapeutic plasma exchange (TPE) for immunized-PTR remain controversial. The study included 83 Ab-negative non-PTR patients and 65 patients with severe immunized-PTR who underwent allo-HSCT. Based on pre-transplant desensitization, 30 and 35 patients were classified into the Ab-positive PTR-treatment and Ab-positive PTR groups. After desensitization, HLA antibodies were decreased (71 ± 19 vs. 26 ± 22, P <0.01), 14h-corrected count increment (CCI) was increased(14.64 ± 5.36 vs. 2.00 ± 1.33, P <0.001), and the cumulative incidence of platelet engraftment at day 21 and 6 months was higher (93.3% vs. 82.9% in Ab-positive PTR group, P = 0.0002 and 90.0% vs. 67.1% in Ab-positive PTR group, P = 0.0005), significantly. Compared to Ab-positive PTR groups, desensitization leads to a better prognosis in Ab-positive PTR-treatment group (3-year OS: 93.3% vs. 47.0%, P <0.0001; 3-year LFS: 83.0% vs. 48.0%,respectively, P <0.0001). Multivariable analysis revealed that desensitization was independently associated with better OS (HR, 0.068; 95%CI, 0.014-340; P = 0.001) and LFS (HR, 0.090; 95%CI, 0.023-358; P = 0.001) for PTR patients. This result indicates that immunized-PTR is associated with poor outcomes in HM patients after allo-HSCT, and desensitization with RTX and TPE achieve favorable outcomes.