目的  探讨分析双重膜滤过式血浆置换(double filtration plasmapheresis，DFPP)联合脱敏治疗单倍体相合造血干细胞移植供者特异性抗体(donor specific antibody，DSA)的疗效。 方法  采用DFPP联合丙种免疫球蛋白(intravenous immunoglobulin,IVIG)、利妥昔单抗脱敏治疗DSA阳性患者，检测移植前后DSA水平，主要评估分析其植入情况。 结果 8例DSA性患者7例获得供者细胞稳定植入，嵌合率均为100%，1例血小板植入不良。经过DFPP、IVIG、利妥昔单抗脱敏处理后为平均荧光强度(mean fluorescence intensity，MFI)(3911±2499)，均明显降低，差异均有统计学意义(t=2.101，P＜0.001)，8例患者中有3例转为弱阳性。干细胞回输第3天复测MFI(907士997),较干细胞回输前再次减低，差异均有统计学意义(t=2.145,P=0.002)。8例患者仅1例发生重度急性移植物抗宿主病。 结论 双重膜滤过式血浆置换脱敏联合大剂量IVIG和利妥昔单抗,尽量输注高剂量的干细胞，可以降低DSA水平促进供者干细胞植入。

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.