Antibodies directed against donor-specific HLA loci (DSA) has been proved as a main culprit for graft rejection, more specifically in HLA mismatched and haplo-identical transplant settings. There is no standardized regimen to manage the presence of DSAs in allogeneic stem cell transplantations (allo-SCTs). Most widely regimen includes combination of rituximab (anti CD20 antibody), Immunoglobulin (IVIG), plasma exchange, and buffy coat infusion, which is costly and time-consuming. Daratumumab (anti CD38 monoclonal antibody) is an effective therapeutic agent to deplete plasma cells and hence, it has a potential to reduce DSA. It has been utilized widely in solid organ transplantation for this purpose. We used this agent in two haplo-identical transplant patients to eliminate or reduce DSA. We observed definite either reduction or elimination in DSA levels in these cases and we could perform haplo-identical transplantation without much delay and with successful primary engraftment in both scenarios. We emphasize that literature on real-world utilization of daratumumab in allo-SCTs is limited. However, it has been utilized widely in solid organ transplantation for this purpose. Our experience with daratumumab regarding effective reduction of DSA followed by successful engraftment might encourage its use in de-sensitization protocols without much delay in transplantation.

针对供体特异性 HLA 基因座 (DSA) 的抗体已被证明是移植物排斥反应的主要原因，特别是在 HLA 不匹配和单倍体相同的移植环境中。没有标准化的方案来管理同种异体干细胞移植 (allo-SCT) 中 DSA 的存在。最广泛的治疗方案包括利妥昔单抗（抗 CD20 抗体）、免疫球蛋白（IVIG）、血浆置换和血沉棕黄层输注的组合，这是昂贵且耗时的。Daratumumab（抗 CD38 单克隆抗体）是一种有效消耗浆细胞的治疗剂，因此有可能减少 DSA。为此目的，它已广泛应用于实体器官移植。我们在两名单倍体移植患者中使用了这种药物来消除或减少 DSA。我们观察到这些病例中 DSA 水平明显降低或消除，并且我们可以在没有太多延迟的情况下进行单倍体移植，并且在这两种情况下都可以成功进行初次植入。我们强调，关于在同种异体干细胞移植中实际使用达雷妥尤单抗的文献是有限的。然而，为此目的，它已广泛应用于实体器官移植。我们使用达雷妥尤单抗有效减少 DSA 并随后成功植入的经验可能会鼓励其在脱敏方案中使用，而不会在移植过程中造成太大延迟。