Abstract

We found that 8 of 10 patients with aplastic anemia experienced resolution of platelet transfusion refractoriness following daratumumab administration. Notably, 4 responders achieved hematopoietic recovery, including 3 participants who showed improvements in multilineage blood cell counts, even with daratumumab monotherapy. This trial was registered at www.clinicaltrials.gov as #NCT05832216.

1.
Trial to Reduce Alloimmunization to Platelets Study Group
.
Leukocyte reduction and ultraviolet B irradiation of platelets to prevent alloimmunization and refractoriness to platelet transfusions
.
N Engl J Med
.
1997
;
337
(
26
):
1861
-
1869
.
2.
Liu
Y
,
Zhang
Y
,
Chen
D
,
Fu
Y
.
Current status of and global trends in platelet transfusion refractoriness from 2004 to 2021: a bibliometric analysis
.
Front Med (Lausanne)
.
2022
;
9
:
873500
.
3.
Song
X
,
Qi
J
,
Li
X
, et al
.
Exploration of risk factors of platelet transfusion refractoriness and its impact on the prognosis of hematopoietic stem cell transplantation: a retrospective study of patients with hematological diseases
.
Platelets
.
2023
;
34
(
1
):
2229905
.
4.
Yankee
RA
,
Graff
KS
,
Dowling
R
,
Henderson
ES
.
Selection of unrelated compatible platelet donors by lymphocyte HL-A matching
.
N Engl J Med
.
1973
;
288
(
15
):
760
-
764
.
5.
Jia
Y
,
Li
W
,
Liu
N
, et al
.
Prevalence of platelet-specific antibodies and efficacy of crossmatch-compatible platelet transfusions in refractory patients
.
Transfus Med
.
2014
;
24
(
6
):
406
-
410
.
6.
Chen
SH
,
Liang
DC
,
Lin
M
.
Treatment of platelet alloimmunization with intravenous immunoglobulin in a child with aplastic anemia
.
Am J Hematol
.
1995
;
49
(
2
):
165
-
166
.
7.
Yu
QH
,
Shen
YP
,
Ye
BD
,
Zhou
YH
.
Successful use of rituximab in platelet transfusion refractoriness in a multi-transfused patient with myelodysplastic syndrome
.
Platelets
.
2015
;
26
(
2
):
195
-
196
.
8.
Cid
J
,
Magnano
L
,
Acosta
M
,
Alba
C
,
Esteve
J
,
Lozano
M
.
Rituximab, plasma exchange and intravenous immunoglobulins as a new treatment strategy for severe HLA alloimmune platelet refractoriness
.
Platelets
.
2015
;
26
(
2
):
190
-
194
.
9.
Mauro
M
,
Camoglio
F
,
Piccoli
P
, et al
.
The use of splenectomy to manage platelet transfusion refractoriness due to anti-human leukocyte antibodies in allogeneic stem cell transplantation
.
Pediatr Rep
.
2016
;
8
(
1
):
6159
.
10.
Bensinger
WI
,
Buckner
CD
,
Clift
RA
,
Slichter
SJ
,
Thomas
ED
.
Plasma exchange for platelet alloimmunization
.
Transplantation
.
1986
;
41
(
5
):
602
-
605
.
11.
Gao
M
,
Huang
J
,
Shao
Y
, et al
.
Efficacy of anti-thymocyte globulin for platelet transfusion refractoriness in serious aplastic anemia patients
.
Transfus Apher Sci
.
2022
;
61
(
3
):
103376
.
12.
Vo
P
,
Purev
E
,
West
KA
, et al
.
A pilot trial of complement inhibition using eculizumab to overcome platelet transfusion refractoriness in human leukocyte antigen allo-immunized patients
.
Br J Haematol
.
2020
;
189
(
3
):
551
-
558
.
13.
Panch
SR
,
Guo
L
,
Vassallo
R
.
Platelet transfusion refractoriness due to HLA alloimmunization: evolving paradigms in mechanisms and management
.
Blood Rev
.
2023
;
62
:
101135
.
14.
Arthur
CM
,
Patel
SR
,
Sullivan
HC
, et al
.
CD8+ T cells mediate antibody-independent platelet clearance in mice
.
Blood
.
2016
;
127
(
14
):
1823
-
1827
.
15.
Muñoz
P
,
Mittelbrunn
M
,
de la Fuente
H
, et al
.
Antigen-induced clustering of surface CD38 and recruitment of intracellular CD38 to the immunologic synapse
.
Blood
.
2008
;
111
(
7
):
3653
-
3664
.
16.
Partida-Sánchez
S
,
Goodrich
S
,
Kusser
K
,
Oppenheimer
N
,
Randall
TD
,
Lund
FE
.
Regulation of dendritic cell trafficking by the ADP-ribosyl cyclase CD38: impact on the development of humoral immunity
.
Immunity
.
2004
;
20
(
3
):
279
-
291
.
17.
Piedra-Quintero
ZL
,
Wilson
Z
,
Nava
P
,
Guerau-de-Arellano
M
.
CD38: an immunomodulatory molecule in inflammation and autoimmunity
.
Front Immunol
.
2020
;
11
:
597959
.
18.
Chen
Y
,
Xu
Y
,
Li
H
, et al
.
A novel anti-CD38 monoclonal antibody for treating immune thrombocytopenia
.
N Engl J Med
.
2024
;
390
(
23
):
2178
-
2190
.
19.
Migdady
Y
,
Ediriwickrema
A
,
Jackson
RP
, et al
.
Successful treatment of thrombocytopenia with daratumumab after allogeneic transplant: a case report and literature review
.
Blood Adv
.
2020
;
4
(
5
):
815
-
818
.
20.
Stanworth
SJ
,
Navarrete
C
,
Estcourt
L
,
Marsh
J
.
Platelet refractoriness--practical approaches and ongoing dilemmas in patient management
.
Br J Haematol
.
2015
;
171
(
3
):
297
-
305
.
21.
Chinese Society of Hematology, Chinese Medical Association
.
Chinese expert consensus on the diagnosis and management of platelet transfusion refractoriness (2022) [in Chinese].
.
Zhonghua Xue Ye Xue Za Zhi
.
2022
;
43
(
11
):
897
-
902
.
22.
Han
MH
,
Badami
KG
.
ABO non-identical platelet transfusions, immune platelet refractoriness and platelet support
.
Br J Haematol
.
2024
;
204
(
5
):
2097
-
2102
.
23.
Young
NS
.
Aplastic anemia
.
N Engl J Med
.
2018
;
379
(
17
):
1643
-
1656
.
24.
You
X
,
Yang
Q
,
Yan
K
, et al
.
Multi-omics profiling identifies pathways associated with CD8+ T-cell activation in severe aplastic anemia
.
Front Genet
.
2021
;
12
:
790990
.
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