Autoimmune thrombocytopenia after autologous bone marrow transplantation

Vela, J. A. Garcia; Oña, F.; Monteserin, M. C.; Lastra, Alejandra; Laraña, J García; López, Javier; Oteyza, Jaime Pérez de; Odriozola, J

doi:10.1002/ajh.2830460427

Cited by 7 publications

(5 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These include transient immune system imbalance post transplant, impaired suppressor T cell function, immune dysregulation due to thymic function damage caused by irradiation and chemotherapy, imbalances in the helper/suppressor T cell populations, altered expression of self antigens occurring as a result of physical damage to stem cells during in vitro handling of marrow prior to reinfusion and viral infections that occur during the post-transplant period. 6 Our patient had a marked increase in T lymphocytes and there was an inversion of the CD4/CD8 ratio.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Autoimmune thrombocytopenia following autologous hematopoietic cell transplantation: review of literature and treatment options

Jillella

Kallab

Kutlar

2000

Bone Marrow Transplant

View full text Add to dashboard Cite

Summary:Autoimmune thrombocytopenia after high-dose chemotherapy and autologous bone marrow/peripheral blood stem cell transplantation occurs infrequently and only six cases meeting the criteria have been reported in the literature. All six of these patients had either acute myelogenous leukemia (AML) or lymphoblastic lymphoma (LBL). Immune thrombocytopenia following autologous transplantation in solid tumors has not been reported. We report the first case of autoimmune thrombocytopenia after high-dose chemotherapy and peripheral blood stem cell transplantation in a patient with breast cancer. A review of the literature has been conducted and treatment options are discussed. In two patients the condition resolved with treatment and in a third patient it improved. Immune-mediated thrombocytopenia in the post-transplant period is one of the causes of a low platelet count. It should be recognized promptly and treated. Bone Marrow Transplantation (2000) 26, 925-927. Keywords: breast cancer; autologous stem cell transplantation; autoimmune thrombocytopenia; ITP The etiology of thrombocytopenia in the post-autologous transplantation period is extensive but usually includes causes such as delayed engraftment, infections, myelosuppressive effect of drugs and disease relapse. A rare cause of thrombocytopenia is immune-mediated destruction of platelets. There are several reports of immune-mediated thrombocytopenia after allogeneic transplantation. 1,2 However, there are few reported cases of autoimmune thrombocytopenia after autologous transplantation. A review of the literature revealed six well-documented cases of this phenomenon. [2][3][4][5][6] All the reported cases occurred in patients with either acute myelogenous leukemia or lymphoblastic lymphoma. To date, no cases of this phenomenon after autologous transplantation for solid tumors have been reported. The following is the first reported case of immune-mediated thrombocytopenia following myeloablCorrespondence: Dr AP Jillella, Section of Heme/Onc, BAA 5407, Medical College of Georgia, 1120 15th Street, Augusta, GA 30912, USA Received 11 May 2000; accepted 28 July 2000 ative chemotherapy and peripheral blood stem cell transplantation for breast cancer. The literature of this rare entity has been reviewed and the treatment options and outcome in these patients are discussed. Case historyA 58-year-old white female was diagnosed with a 2 ϫ 2.5 cm lobular carcinoma for which she had a right modified radical mastectomy and axillary lymph node dissection. Twenty-one of 25 lymph nodes were positive for disease and the estrogen and progesterone receptors were positive. The only other significant past medical condition was vitiligo on the trunk. Because of the high risk of relapse, she was felt to be an appropriate candidate for high-dose chemotherapy and stem cell transplantation. She received four cycles of standard-dose chemotherapy with doxorubicin and cyclophosphamide (AC) followed by restaging which revealed no evidence of metastatic disease. Her complete blood count...

show abstract

Section: Discussionmentioning

confidence: 99%

“…A review of the literature revealed six well-documented cases of this phenomenon. [2][3][4][5][6] All the reported cases occurred in patients with either acute myelogenous leukemia or lymphoblastic lymphoma. To date, no cases of this phenomenon after autologous transplantation for solid tumors have been reported.…”

Section: Discussionmentioning

confidence: 99%

Autoimmune thrombocytopenia following autologous hematopoietic cell transplantation: review of literature and treatment options

Jillella

Kallab

Kutlar

2000

Bone Marrow Transplant

View full text Add to dashboard Cite

show abstract

“…Autoimmune cytopenias are probably the most common autoimmune disorders after BMT: not only have autoimmune neutropenia, thrombocytopenia and haemolytic anaemia been reported separately, but there have even been reports of patients with a combination of two of these disorders, or with a pancytopenia. [46][47][48][49][50][51][52][53][54][55][56][57] Interestingly, these autoimmune cytopenias developed after either allogeneic or autologous, and even post-T-cell-depleted BMT. Immune cytopenia is one of the major causes of post-BMT cytopenia; when considering, for example, the pathogenesis of immune haemolytic anaemia after BMT, few different mechanisms can be found: 58,59 (1) Major ABO/Rh incompatibility, which results in an immediate reaction between donor RBC and pre-exist-ing recipient antibodies.…”

Section: Autoimmune Cytopeniasmentioning

confidence: 99%

Autoimmune diseases and autoimmunity post-bone marrow transplantation

Sherer

Shoenfeld

1998

Bone Marrow Transplant

175

153

View full text Add to dashboard Cite

BMT can both transmit and eliminate autoimmune diseases, and hence it has been suggested as an optional treatment for severe autoimmune conditions. In this communication we deal with the question of whether chronic GVHD is an autoimmune disease in itself, review the literature reports of autoimmune diseases following BMT in humans, and describe the autoimmune nature of the post-BMT state. Chronic GVHD, which is a frequent complication post-BMT, has clinical and pathogenic characteristics similar to autoimmune diseases, such as scleroderma and Sjogren's syndrome. Although the pathogenesis of chronic GVHD is not yet clear, thymic damage induced by acute GVHD may contribute to both the immunodeficiency and autoimmunity characterising chronic GVHD. A similar phenomenon is syngeneic GVHD, which results from an imbalance between autoreactive and autoregulatory lymphocytes. Additionally, other autoimmune diseases have been reported in post-BMT patients, and among these the most common are hypothyroidism, hyperthyroidism, myasthenia gravis and immune cytopenias. Although these diseases also occur also outside the post-BMT setting, they are unique with respect to pathogenesis (no association between myasthenia gravis and thymic pathology), diagnosis (symptoms of hyperthyroidism may be inadvertently related to other conditions), and prognosis (post-BMT autoimmune cytopenias may be fatal and treatment non-responsive). Nevertheless, many other autoimmune diseases have been reported after BMT, and these are mainly presented as case reports. Regarding the mechanism of post-BMT autoimmunity, the minority of cases stem from donor-related transfer of pathogenic lymphocytes or their progenitors, while most of the cases (either chronic GVHD or specific diseases) can be attributed to the immunologic imbalances characterising the post-BMT setting. The factors that may expose an individual to autoimmunity development post-BMT include genetic predisposition, an environmental factor such as CMV, and the nature of the donor who may aid in creating microchimerism and subsequently chronic GVHD and its related autoimmune manifestations.

show abstract

“…As we thought that it was not Evans syndrome but the multiple myeloma that was the biggest risk to his life, we chose high-dose melphalan as the treatment as it has been shown to achieve deeper remission, and the deeper remission often equates to a longer survival (25,26 (27) …”

Section: The Development Of Autoimmune Diseases After Autologous or Amentioning

confidence: 99%

Refractory Evans Syndrome after Autologous Stem Cell Transplantation for Multiple Myeloma: Management with a Second Transplantation

et al. 2010

View full text Add to dashboard Cite

show abstract

Autoimmune thrombocytopenia after autologous bone marrow transplantation

Cited by 7 publications

References 5 publications

Autoimmune thrombocytopenia following autologous hematopoietic cell transplantation: review of literature and treatment options

Autoimmune thrombocytopenia following autologous hematopoietic cell transplantation: review of literature and treatment options

Autoimmune diseases and autoimmunity post-bone marrow transplantation

Refractory Evans Syndrome after Autologous Stem Cell Transplantation for Multiple Myeloma: Management with a Second Transplantation

Contact Info

Product

Resources

About