HLA Class I Allele Loss and Bone Marrow Transplantation Outcomes in Immune Aplastic Anemia

Zaimoku, Yoshitaka; Katagiri, Takamasa; Nakagawa, Noriharu; Imi, Tatsuya; Maruyama, Hiroyuki; Takamatsu, Hiroyuki; Ishiyama, Ken; Yamazaki, Hirohito; Miyamoto, Toshihiro; Nakao, Shinji

doi:10.1016/j.jtct.2023.11.013

Transplantation and Cellular Therapy

2024

DOI: 10.1016/j.jtct.2023.11.013

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HLA Class I Allele Loss and Bone Marrow Transplantation Outcomes in Immune Aplastic Anemia

Yoshitaka Zaimoku,

Takamasa Katagiri,

Noriharu Nakagawa

et al.

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2024

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Cited by 3 publications

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Haematopoietic regeneration by HLA‐A*0206‐deficient clones in severe aplastic anaemia without definitive immunosuppressive treatment

Zaimoku,

Sakai,

Tsuji

et al. 2024

Br J Haematol

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SummaryWe describe the case of a 74‐year‐old man with severe aplastic anaemia who experienced persistent remission attributed to proliferation of HLA allele‐deficient clones. Despite an initial worsening of pancytopenia with eltrombopag and ciclosporin treatment, gradual trilineage haematopoietic recovery occurred, with blood counts normalizing over 3 years. Flow cytometry and deep nucleotide sequencing revealed that haematopoiesis was primarily supported by several clones with somatic mutations that inactivated antigen presentation via HLA‐A*0206. This suggests that monitoring haematopoietic regeneration by immune escape clones could be an alternative approach for immune aplastic anaemia patients who possess HLA allele‐deficient clones and cannot tolerate standard therapy.

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Haematopoietic regeneration by HLA‐A*0206‐deficient clones in severe aplastic anaemia without definitive immunosuppressive treatment

Zaimoku,

Sakai,

Tsuji

et al. 2024

Br J Haematol

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HLA‐lacking clones in aplastic anaemia: Adaptive or maladaptive?

Gurnari,

Lima,

Pagliuca

2024

Br J Haematol

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HLA loss represents the result of immune forces shaping bone marrow clonal dynamics in immune aplastic anaemia. Human leukocyte antigen (HLA)‐deficient clones may rescue haematopoiesis by evading immune attacks, potentially guiding treatment strategies.Commentary on: Zaimoku et al. Haematopoietic regeneration by HLA‐A*0206‐deficient clones in severe aplastic anaemia without definitive immunosuppressive treatment. Br J Haematol 2024 (Online ahead of print). doi: 10.1111/bjh.19712.

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Modified Delphi panel consensus recommendations for management of severe aplastic anemia

Babushok,

DeZern,

de Castro

et al. 2024

Blood Advances

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Severe aplastic anemia (SAA) is a rare hematologic condition for which there is no clear management algorithm. A panel of 11 adult and pediatric experts on aplastic anemia was assembled and, using the RAND/UCLA modified Delphi panel method, evaluated >600 varying patient care scenarios to develop clinical recommendations for the initial and subsequent management of patients of all ages with SAA. Here we present the panel's recommendations to rule out inherited bone marrow failure (IBMF) syndromes, on supportive care prior to and during first-line therapy, and on first-line (initial management) and second-line (subsequent management) therapy of acquired SAA, focusing on when transplant versus medical therapy is most appropriate. These recommendations represent the consensus of 11 experts informed by published literature and experience. They are intended only as general guidance for experienced clinicians who treat patients with SAA and are in no way intended to supersede individual physician and patient decision-making. Current and future research should validate this consensus using clinical data. Once validated, we hope these expert panel recommendations will improve outcomes for patients with SAA.

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HLA Class I Allele Loss and Bone Marrow Transplantation Outcomes in Immune Aplastic Anemia

Cited by 3 publications

References 24 publications

Haematopoietic regeneration by HLA‐A*0206‐deficient clones in severe aplastic anaemia without definitive immunosuppressive treatment

Haematopoietic regeneration by HLA‐A*0206‐deficient clones in severe aplastic anaemia without definitive immunosuppressive treatment

HLA‐lacking clones in aplastic anaemia: Adaptive or maladaptive?

Modified Delphi panel consensus recommendations for management of severe aplastic anemia

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