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

Abstract

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...

Characterization of hemopoietic engraftment kinetics and development of secondary cytopenia in AML post auto-SCT and its correlation with survival outcome

“…26,27,[39][40][41] The immunological mechanism was explored by Ninan et al 26 in their study, but it did not show any autoimmune basis in their patients, neither was there any response in the plt counts with i.v. Ig administration.…”

Development of rheumatoid arthritis following autologous peripheral blood stem cell transplantation

“…2,3 Autoimmune thrombocytopenia following autologous hematopoietic cell transplantation, for example, has been described in patients with acute myelogenous leukemia, lymphoblastic lymphoma, or breast cancer, 6 but the exact mechanism is not known. Several possibilities have been proposed, which include transient immune system imbalance post transplant, impaired suppressor T cell function, immune dysregulation due to thymic damage caused by chemoradiotherapy, and altered expression of self-antigens occurring as a result of physical damage to stem cells during marrow handling, or viral infections.…”

Autoimmune thrombocytopenic purpura after autologous stem cell transplantation

“…In most of the present cases and in previous reports, thrombocytopenia occurred less than 1 year after autologous transplant, over the time frame of altered immune reconstitution. 1,8,21 The spontaneous remission of autoimmune manifestations after the period necessary for a full immunological recovery may also suggest that altered immune reconstitution could be important. Finally, other factors suspected to be involved in impaired T cell functions were also found in some patients: previous fludarabine treatment (known to be associated with occurrence of autoimmune hemolytic anemia 22 ) or use of TBI (which may alter thymic function and recovery or function of regulatory lymphocytes 23,24 ).…”