Efficacy of D– red blood cell transfusion and rituximab therapy in autoimmune hemolytic anemia with anti‐D and panreactive autoantibodies arising after hematopoietic stem cell transplant

Minakawa, Keiji; Ohto, Hitoshi; Yasuda, Hiroyasu; Saito, Shunichi; Kawabata, Kinuyo; Ogawa, Kaoru; Nollet, Kenneth E.; Ikeda, Kazuhiko

doi:10.1111/trf.14634

Cited by 4 publications

(3 citation statements)

References 19 publications

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“…27,28 Several previous studies also reported that rituximab could be used for DSA desensitization in patients receiving Haplo-HSCT. 21,[29][30][31][32] Recently, Chang et al 33 demonstrated that treating DSA-positive patients with a single dose of rituximab significantly decreased levels of DSA MFI and reduced primary PGF in patients with DSA 2000 ≤ MFI < 5000. In our protocol, a single dose of rituximab (375 mg/m 2 ) was administrated after completion of DFPP.…”

Section: Discussionmentioning

confidence: 99%

“…Rituximab has been demonstrated to be effective in dealing with DSA‐mediated organ transplant rejection 27,28 . Several previous studies also reported that rituximab could be used for DSA desensitization in patients receiving Haplo‐HSCT 21,29–32 . Recently, Chang et al 33 demonstrated that treating DSA‐positive patients with a single dose of rituximab significantly decreased levels of DSA MFI and reduced primary PGF in patients with DSA 2000 ≤ MFI < 5000.…”

Section: Discussionmentioning

confidence: 99%

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Double filtration plasmapheresis combined with rituximab for donor‐specific antibody desensitization in haploidentical haematopoietic stem cell transplantation

Liu,

Ji,

Zhu

et al. 2023

Br J Haematol

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SummaryDonor‐specific anti‐HLA antibodies (DSA) are a major cause of engraftment failure in patients receiving haploidentical haematopoietic stem cell transplantation (Haplo‐HSCT). Double filtration plasmapheresis (DFPP) avoids the unnecessary loss of plasma proteins and increases the efficiency of purification. To investigate the effectiveness of the desensitization protocol including DFPP and rituximab, we conducted a nested case–control study. Thirty‐three patients who had positive DSA were desensitized by the protocol and 99 patients with negative DSA were randomly matched as control. The median DSA mean fluorescence intensity values before and after DFPP treatment were 7505.88 ± 4424.38 versus 2013.29 ± 4067.22 (p < 0.001). All patients in DSA group achieved haematopoietic reconstitution and the median neutrophils and platelets engraftment times were 13 (10–21) and 13 (10–29) days respectively. Although the cumulative incidence of II–IV aGVHD (41.4% vs. 28.1%) and 3‐year moderate to severe cGVHD (16.8% vs. 7.2%) were higher in DSA cohort than in the control, no statistical significance was observed. The 3‐year non‐relapse mortality and the overall survival were 6.39% and 72.0%, respectively, in the DSA cohort, which were comparable to the negative control. In conclusion, DFPP and rituximab could be effectively used for desensitization and overcome the negative effects of DSA in Haplo‐HSCT.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Double filtration plasmapheresis combined with rituximab for donor‐specific antibody desensitization in haploidentical haematopoietic stem cell transplantation

Liu,

Ji,

Zhu

et al. 2023

Br J Haematol

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“…Since the advent of biological target therapies, a significant improvement of post-allo-HSCT AIHA outcome has been observed. In particular, rituximab induced a response in about 49% of cases in 2nd line (lower than in primary AIHA), and in 88% of cases as 1st line, combined to steroid treatment (comparable to primary cases), again without distinguishing for AIHA type 23–26. In particular, in a study by Sanz et al, 3/4 cases responded to rituximab frontline (2 CR and 1 PR), and 4/4 as second-line treatment (all PR) 23.…”

Section: Biological Treatments For Post-allo-hsct Aihamentioning

confidence: 99%

<p>Management of refractory autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation: current perspectives</p>

Barcellini¹,

Fattizzo²,

Zaninoni³

2019

JBM

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Autoimmune hemolytic anemia (AIHA) is increasingly observed after allogeneic hematopoietic stem cell transplantation (allo-HSCT), with a reported incidence between 4% and 6%. The disease is generally severe and refractory to standard therapy, with high mortality, and there are neither defined therapies, nor prospective clinical trials addressing the best treatment. Most of the knowledge on the therapy of AIHAs derives from primary forms, which are highly heterogeneous as well, further complicating the management of post-allo-HSCT forms. The review addresses the risk factors associated with post-allo-AIHA, including unrelated donor, the development of chronic extensive graft-versus-host disease, CMV reactivation, nonmalignant diagnosis pre-HSCT, and alemtuzumab use in conditioning regimens. Regarding therapy, we describe standard treatments, such as corticosteroids, intravenous immunoglobulin, splenectomy, rituximab, cyclophosphamide, and plasma exchange, which have lower response rates than those reported in primary forms. New therapeutic options, including sirolimus, bortezomib, abatacept, daratumumab and complement inhibitors, are promising tools for this detrimental complication occurring after allo-HSCT.

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Rituximab for desensitization during HLA-mismatched stem cell transplantation in patients with a positive donor-specific anti-HLA antibody

Chang

Wang

et al. 2020

Bone Marrow Transplant

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Efficacy of D– red blood cell transfusion and rituximab therapy in autoimmune hemolytic anemia with anti‐D and panreactive autoantibodies arising after hematopoietic stem cell transplant

Abstract: In severe AIHA, when standard treatment and regular RBC transfusions are ineffective, transfusion of RBCs lacking the target antigen(s) of autoantibodies and administration of anti-CD20 MoAb should be considered.

Cited by 4 publications

References 19 publications

Double filtration plasmapheresis combined with rituximab for donor‐specific antibody desensitization in haploidentical haematopoietic stem cell transplantation

Double filtration plasmapheresis combined with rituximab for donor‐specific antibody desensitization in haploidentical haematopoietic stem cell transplantation

<p>Management of refractory autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation: current perspectives</p>

Rituximab for desensitization during HLA-mismatched stem cell transplantation in patients with a positive donor-specific anti-HLA antibody

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