Antigen-Specific Immunoadsorption With the Glycosorb® ABO Immunoadsorption System as a Novel Treatment Modality in Pure Red Cell Aplasia Following Major and Bidirectional ABO-Incompatible Allogeneic Hematopoietic Stem Cell Transplantation

Handisurya, Ammon; Worel, Nina; Rabitsch, Werner; Bojić, Marija; Pajenda, Sahra; Reindl‐Schwaighofer, Roman; Winnicki, Wolfgang; Vychytil, Andreas; Knaus, Hanna A.; Oberbauer, Rainer; Derfler, Kurt; Wohlfarth, Philipp

doi:10.3389/fmed.2020.585628

Cited by 7 publications

(6 citation statements)

References 30 publications

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“…TPE may also improve post-transplant PRCA by removing persistent recipient isohemagglutinins. ABO-specific immunoadsorption columns have also been used successfully in a small CS (Handisurya, 2020).…”

Section: Rationale For Therapeutic Apheresismentioning

confidence: 99%

Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Ninth Special Issue

Connelly‐Smith

Alquist

Aqui

et al. 2023

J of Clinical Apheresis

167

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The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating, and categorizing indications for the evidence-based use of therapeutic apheresis (TA) in human disease. In the Ninth Edition, the JCA Special Issue Writing Committee has incorporated systematic review and evidence-based approaches in the grading of evidence and categorization of apheresis indications to make recommendations on the use of apheresis in a wide variety of diseases and conditions. This edition has largely maintained the general layout and concept of a fact sheet introduced in the Fourth Edition (2007). Each fact sheet succinctly summarizes the evidence for the use of TA in a specific disease or medical condition. The Ninth Edition of the JCA Special Issue comprises 91 fact sheets and

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Section: Rationale For Therapeutic Apheresismentioning

confidence: 99%

Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Ninth Special Issue

Connelly‐Smith

Alquist

Aqui

et al. 2023

J of Clinical Apheresis

167

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“…EPO-agonist, although widely used for transfusion-dependent anemia, appeared to be not enough to achieve red cell engraftment in patients with erythroid precursor aplasia ( 6 , 17 ). The role of PEX or IA alone can be useful to rapidly reduce the IHA titer, although the effect might be transient and unable to reverse red cell aplasia ( 17 , 24 , 25 , 31 , 32 ). The reduction of immunosuppression can be considered as a possible option, enhancing donor T cell activity against donor residual plasma cells, but it should be carefully weighted given the risk of GVHD flare and the variability of responses ( 16 , 21 – 23 , 26 , 27 , 30 , 32 ).…”

Section: Discussionmentioning

confidence: 99%

Pure red cell aplasia among ABO mismatched hematopoietic stem cell transplant recipients: a 13-years retrospective study and literature review

Metafuni,

Busnego Barreto,

Valentini

et al. 2024

Front. Oncol.

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BackgroundPure red cell aplasia (PRCA) is a possible complication after allogeneic hematopoietic stem cell transplantation (HSCT) with major ABO incompatibility. Patients experience delayed engraftment of the erythroid series, with prolonged transfusion-dependent anemia and iron overload.MethodsWe performed a revision of the most recent literature about post-HSCT PRCA treatment procedures. Moreover, we conducted a retrospective study, over the last 13-years, which included all consecutive major ABO mismatched HSCT performed in our unit, with the aim to assess PRCA incidence, risk factors, and response to different treatments. Overall, 194 patients received a major ABO mismatched transplant from 2010 to 2022. For each patient, data about demographic and transplant characteristics, engraftment, blood transfusion, and possible treatment received were collected.ResultsThe literature review returned 23 eligible papers on PRCA treatment, with high success rate using plasma-exchange (PEX) and immunoadsorption procedures, daratumumab, and eltrombopag. Our study identified a total of 24 cases of PRCA. Among risk factors for PRCA development, we have found older recipient age (p=0.01), high pre-HSCT IgG and IgM IHA titer (p<0.0001), major rather than bidirectional ABO incompatibility (p=0.02), low T CD8 lymphocyte count in the graft (p=0.006), relative donor (p=0.02) and bone marrow as stem cell source (p=0.002). However, multivariate analysis confirmed only pre-HSCT IgG IHA titer as the unique risk factor for PRCA occurrence. The optimal cut-off value of pre-HSCT IgG IHA for PRCA development, resulted to be 1/64, with a 100% sensitivity and 68.8% specificity (p<0.0001). All patients with PRCA had received rhEPO and transfusion support and 20 patients received additional treatments like PEX, rituximab, and more recently daratumumab. Comprehensively, PEX and rituximab obtained a response in half of the cases, at a variable time, while the few cases of patients we treated with daratumumab suggest promising results. The overall response rate in our cohort was 75%, with significantly better survival (94.4% vs. 16.7%) and lower transplant-related mortality (6.3% vs. 80%) for PRCA responders.ConclusionsStandardized guidelines on when and how to treat PRCA are necessary because the current treatment is controversial among centers.

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“…Selective ABO IA is also more efficient to eliminate blood group‐specific IgM compared to other methods 37,38 . Handisurya et al 29 recently published a series of 6 patients with PRCA after HCT treated by selective Glycosorb® ABO IA. The procedure was well‐tolerated and effective with a decrease in IHA titer and finally resolution of PRCA.…”

Section: Discussionmentioning

confidence: 99%

“…In ptPRCA adjustments in immunosuppression regimens or other treatments like rituximab, 21 erythropoietin, 22 daratumumab, 23,24 or anti‐thymocyte globulins 25 tapering of immunosuppressive drugs, 20,26 donor lymphocyte infusions (DLI) 27 are included after allogeneic stem cell transplantation. To avoid ptPRCA therapeutic plasma exchange (TPE), 28 semi‐selective and selective immunoadsorption (IA), 29 have been used to eliminate high IHA before HCT.…”

Section: Introductionmentioning

confidence: 99%

Selective ABO immunoadsorption in hematopoietic stem cell transplantation with major ABO incompatibility

Crysandt

Soysal

Jennes

et al. 2021

European J of Haematology

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Objective ABO mismatch between donor and recipient occurs in 40% of allogeneic hematopoietic stem cell transplantations (HCT). Different strategies have been described to reduce isohemagglutinins (IHA) before HCT. We describe the effect of selective ABO immunoadsorption (ABO IA) on erythrocyte transfusion rate and the development of post‐transplant pure red cell aplasia (ptPRCA). Methods 63 patients with major ABO incompatibility were retrospectively analyzed. Nine patients with major ABO incompatibility and high‐IHA titer were treated by ABO IA before HCT. We analyzed the need for transfusion and the occurrence of ptPRCA. We compared the outcome with patients treated by other methods to reduce IHA. Results In all nine patients treated by ABO IA, IHA decreased in a median four times. PtPRCA occurred in one patient. The median number of transfusions was 8 (range: 0‐36) between d0 and d100. In 25 patients with high‐IHA titer without treatment or treated by other methods to reduce IHA, the need for transfusions was comparable. No difference in the incidence of ptPRCA was observed. Conclusions Selective ABO IA is a feasible, safe, and effective method to reduce IHA before HCT in major ABO incompatibility. No effect on transfusion rate or ptPRCA compared to other strategies could be observed.

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Antigen-Specific Immunoadsorption With the Glycosorb® ABO Immunoadsorption System as a Novel Treatment Modality in Pure Red Cell Aplasia Following Major and Bidirectional ABO-Incompatible Allogeneic Hematopoietic Stem Cell Transplantation

Cited by 7 publications

References 30 publications

Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Ninth Special Issue

Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Ninth Special Issue

Pure red cell aplasia among ABO mismatched hematopoietic stem cell transplant recipients: a 13-years retrospective study and literature review

Selective ABO immunoadsorption in hematopoietic stem cell transplantation with major ABO incompatibility

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