Autoimmune cytopenias after umbilical cord blood transplantation in adults with hematological malignancies: a single-center experience

Abstract

We describe incidence, clinical features, serological data, response to therapy and outcome of autoimmune cytopenias (ACs), including autoimmune hemolytic anemia (AIHA) and autoimmune thrombocytopenia (AIT) in a series of 281 consecutive adults with hematological malignancies that received single-unit umbilical cord blood transplantation (UCBT) at a single institution. AIHA was diagnosed in 15 patients at a median time of 181 days (range, 25-543), 12 of them had cold antibodies (IgM). The 3-year cumulative incidence (CI) of AIHA was 5.4% (CI 95% 2.7-8.1). Concomitant infections at the time of AIHA were present in 10 patients. Five out of nine patients that received corticosteroids achieved either a PR or a CR, whereas six out of eight patients that received rituximab responded. Four patients developed AIT giving a 3-year CI of 1.4% (CI 95% 0-2.8), concomitant infections were present in three of them. Multivariable analysis showed that development of chronic GVHD (relative risk (RR) 4; 95% CI 1.1-13.7; P = 0.03) and diagnosis of CML (RR 4.3; 95% CI 1.5-12.7; P = 0.008) were associated with an increased risk of AC. In conclusion, AIHA and AIT are relevant and clinically significant complications in UCBT recipients, especially among those that develop chronic GVHD. Response to therapy is sub-optimal, and rituximab should be considered as a therapeutic option, in this setting were most patients had cold AIHA and a serological profile similar to that seen in cold agglutinin disease.

Autoimmune hemolysis and immune thrombocytopenic purpura after cord blood transplantation may be life-threatening and warrants early therapy with rituximab

“…Conversely, Sanz et al has reported a 5.4% incidence of AH and 1.4% incidence of ITP in adult single unit CBT recipients at 3 years post-transplant. (REF 11) In contrast to our report, the majority of AH patients in this analysis had cold agglutinins, concomitant viral infections, and chronic GVHD and this complication was associated with a high mortality.…”

“…However, the literature describing the manifestations of AH and ITP after CBT is limited and the optimal therapy is not established. (REF 7, 8, 9, 10, 11). We performed a retrospective study to characterize the incidence, severity, treatment response, and prognosis of these autoimmune cytopenias in CBT recipients transplanted at our center.…”

Autoimmune hematological diseases following haploidentical donor hematopoietic stem cell transplant compared with matched sibling and unrelated donor

“…The risk factors of AHDs were mainly associated with source of donors, cGVHD [6, 8], lymphocyte depletion of graft with ex vivo lymphodepletion or in vivo lymphodepletion using ATG or alemtuzumab [7, 13, 22], younger [9] and HLA typing [13] and peripheral blood stem cells, and so on [2]. Our results showed that HRD and cGVHD were the risk factor of AHDs.…”

Cold agglutinin disease burden: a longitudinal analysis of anemia, medications, transfusions, and health care utilization

“…4,10,11,16,17,20,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] To our knowledge, our study is the first to describe individual disease courses over time, 11,16,28 transfusion-dependent. Our study is also the first to characterize HRU in CAD, which is substantial in this population.…”

“…26,27,31,34,36 Other causes of death included severe anemia complications, 34 ischemic stroke, 40 and infection. 31 In the first year after disease onset, 67% of our cohort used inpatient services at Stanford, 100% used outpatient, and about 50% used emergency services. The median number of CAD-related outpatient visits in the first year after disease onset was 26, representing a significant burden on the patient and the medical system.…”