Daratumumab may be the most effective treatment for post-engraftment pure red cell aplasia due to persistent anti-donor isohemagglutinins after major ABO-mismatched allogeneic transplantation

Martino, Rodrigo; García‐Cadenas, Irene; Esquirol, Albert

doi:10.1038/s41409-021-01507-3

Cited by 16 publications

(16 citation statements)

References 15 publications

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“…Apart from five patients with PRCA receiving transfusion and IVIG only in our study, six patients were treated with TPE additionally and achieved definite treatment effect. In patients with refractory PRCA, daratumumab, eltrombopag, and rituximab may be effective strategies in previous cases (35)(36)(37)(38).…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Pure Red Cell Aplasia Following Major ABO-Incompatible Hematopoietic Stem Cell Transplantation

Zhu

Cui

et al. 2022

Front. Immunol.

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BackgroundPure red cell aplasia (PRCA) is one of the important complications in major ABO-incompatible allogeneic hematopoietic stem cell transplantation (HSCT). The established pathogenic factor of PRCA is the persistence of high anti-donor isohemagglutinins. As previously verified, the conditioning regimen and donor type were the factors associated with the development of PRCA in the small-sized studies. Currently, the prevalence, risk factors, and prognosis of PRCA are still worth studying to provide evidence.MethodsWe conducted a prospective nested case-control study to determine the prevalence, donor-related factors, and the outcomes of PRCA following major ABO-incompatible transplantation. A total of 469 patients who underwent ABO-incompatible grafts were observed.ResultsNone of the patients were diagnosed with PRCA with minor or bidirectional ABO-incompatible HSCT. Thirteen of the187 patients (7%; 95% confidence interval [CI], 3.9%–11.9%) developed PRCA following major ABO-incompatible HSCT. Eleven of the 13 patients with PRCA recovered entirely. Donor type was an independent factor associated with post-HSCT PRCA (odds ratio [OR]=0.030; 95% CI, 0.003–0.321; P=0.004). The cumulative incidence rates of post-HSCT PRCA in the context of major ABO-incompatible HSCT were 0.8%, 13.1%, and 27.2% for the haploidentical donor (HID), unrelated donor, and matched related donor, respectively. No significant influence of PRCA on transplantation outcomes was observed.In conclusion, post-HSCT PRCA is a rare and less threatening complication in major ABO-incompatible HSCT. The majority of patients with PRCA could recover. Additionally, HIDs for recipients may have a low risk of post-HSCT PRCA. This trial was registered at www.chictr.org.cn (#ChiCTR2000041412).

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Section: Discussionmentioning

confidence: 99%

Prevalence of Pure Red Cell Aplasia Following Major ABO-Incompatible Hematopoietic Stem Cell Transplantation

Zhu

Cui

et al. 2022

Front. Immunol.

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“…З А К Л Ю Ч Е Н И Е Полученные данные, а также отдельные публи кации по данному вопросу дают основание судить о потенциальной безопасности и эф ф екти в ности даратумумаба в качестве терапии ПККА как у взрослых реципиентов ТГСК, так и у детей [2][3][4][5][14][15][16][17][18]. Предположения о механизме патоге неза ПККА у данной группы пациентов дают осно вания рассматривать возможность применения 112 КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯ даратумумаба в первой линии терапии, что, безус ловно, заслуживает более предметного анализа [3,12].…”

Section: периферическая кровьunclassified

“…В 2018 г. C. Chapuy и соавт., опираясь на ранее опубликованный другими авторами положительный опыт применения даратумумаба в режиме, применя емом у больных с множественной миеломой, впервые продемонстрировали успешный случай использо вания данного препарата у пожилого реципиента с миелодиспластическим синдромом, развернувшим ПККА после ТГСК с немиелоаблативным кондицио нированием [14]. Даратумумаб -это моноклональное антитело, которое связывается с белком CD38, характеризующимся высоким уровнем экспрессии на поверхности плазмобластов и плазматических клеток, в том числе и продуцирующих изогемагглютинины [15][16][17]. Fab-фрагмент даратумумаба связы вается с CD38-антигеном на плазматических клетках и при участии Fc-домена инициирует иммуноло гические реакции, опосредующие лизис В-клеток.…”

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“…Возможные механизмы клеточного лизиса включают комплемент-и антителозависимую клеточно-опосре дованную цитотоксичность [16]. В профильных высо корейтинговых изданиях все чаще можно встретить описания клинических случаев эффективного приме нения даратумумаба в лечении ПККА у больных после ТГСК [2][3][4][5][15][16][17][18].…”

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Daratumumab in the treatment of pure red cell aplasia after pediatric allogeneic stem cell transplantation

Arakelyan

Blagov

Kovrygin

et al. 2023

Voprosy gematologii/onkologii i immunopatologii v pediatrii

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Pure red cell aplasia (PRCA) is a rare complication of AB0-incompatible allogeneic hematopoietic stem cell transplantation, which manifests as a partial or complete absence of erythroid lineage in recipients with normal function of other hematopoietic lineages. There is a hypothesis, that lysis of erythroid precursors occurs because of antibody formation by population of residual B-lymphocytes and/or long-lived recipient’s plasma cells, which are capable for proliferation and active expression of the CD38 marker. That is why the invention of the IgG1 monoclonal antibody to CD38 presented as a new potentially effective targeted therapeutic option for patients with refractory PPCA. The article summarize clinical data on daratumumab for the therapy of PRCA in pediatric allogeneic hematopoietic stem cell transplantation recipients. The patients' parents gave their consent to the use of their children's data, including photographs, for research purposes and in publications.

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“…Most recently, successful treatment of PRCA following ABO-incompatible stem cell transplant with daratumumab has been described in a total of ten cases with rapid and prolonged remission achieved after two to four doses of therapy. 4-6 In the aforementioned situation, clinical response was attributed to elimination of the residual recipient plasma cells and reduction in isohemagglutinin titers. In our patient, PRCA was not necessarily associated with MGUS given the lack of therapeutic benefit with bortezomib.…”

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confidence: 99%

Daratumumab for treatment-refractory acquired idiopathic pure red cell aplasia

et al. 2022

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Daratumumab may be the most effective treatment for post-engraftment pure red cell aplasia due to persistent anti-donor isohemagglutinins after major ABO-mismatched allogeneic transplantation

Cited by 16 publications

References 15 publications

Prevalence of Pure Red Cell Aplasia Following Major ABO-Incompatible Hematopoietic Stem Cell Transplantation

Prevalence of Pure Red Cell Aplasia Following Major ABO-Incompatible Hematopoietic Stem Cell Transplantation

Daratumumab in the treatment of pure red cell aplasia after pediatric allogeneic stem cell transplantation

Daratumumab for treatment-refractory acquired idiopathic pure red cell aplasia

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