Resistant pure red cell aplasia after allogeneic stem cell transplantation with major ABO mismatch treated by escalating dose donor leukocyte infusion

Verholen, Frank; Stalder, M; Helg, Claudine; Chalandon, Yves

doi:10.1111/j.1600-0609.2004.00320.x

Cited by 44 publications

(25 citation statements)

References 41 publications

(45 reference statements)

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“…48,49 If this strategy is not successful, several other strategies have been proposed according to the pathophysiology of the disorder: plasmapheresis, 43,46,64 antithymocyte globulin, 38,41 erythropoietin, 39,42,44,61 corticosteroids, 53,56 rituximab, 47,54 and donorlymphocyte infusions to induce GvHD. 45,51 Virtually all of these treatments have only been evaluated in a few patients or in single case reports. In our cohort, one patient was treated with plasmapheresis without clinical improvement; all other patients received supportive treatment with RBC transfusions and iron chelation if necessary.…”

Section: © F E R R a T A S T O R T I F O U N D A T I O Nmentioning

confidence: 99%

Prevention of pure red cell aplasia after major or bidirectional ABO blood group incompatible hematopoietic stem cell transplantation by pretransplant reduction of host anti-donor isoagglutinins

Stüssi¹,

Halter²,

Bucheli

et al. 2009

Haematologica

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BackgroundPersistent anti-donor isoagglutinins after major ABO blood group incompatible hematopoietic stem cell transplantation may cause delayed red blood cell engraftment and post-transplant pure red cell aplasia. Design and MethodsWe investigated the effect of pretransplant anti-donor isoagglutinin reduction by in vivo absorption and/or plasmapheresis on the incidence of pure red cell aplasia and the time to red blood cell engraftment in 153 hematopoietic stem cell transplant recipients with major ABO incompatibility. ResultsTwelve patients (8%) developed pure red cell aplasia, 3/98 (3%) with, and 9/55 (16%) without prior isoagglutinin reduction (p=0.009). Red blood cell engraftment was faster in patients with isoagglutinin reduction; in addition, peripheral blood hematopoietic stem cell transplantation, acute graft-versus-host disease, and younger age were associated with faster red blood cell engraftment in Cox regression analysis. In patients with pure red cell aplasia the mean red blood cell engraftment occurred after 225 days (p<0.001) and was associated with a simultaneous decrease of anti-donor isoagglutinins. Patients with pure red cell aplasia had higher pretransplant anti-donor isoagglutinin titers (p=0.001) and received more post-transplant red blood cell transfusions (p<0.001). ConclusionsFollowing major ABO incompatible hematopoietic stem cell transplantation, pure red cell aplasia and delayed red blood cell engraftment depend on the levels of anti-donor isoagglutinins and are efficiently prevented by the pretransplant removal of these isoagglutinins. The benefits of reducing the time of transfusion-dependency and transfusion-associated risks must be carefully balanced against the potential side effects of isoagglutinin reduction.Key words: ABO blood group incompatibility, allogeneic hematopoietic stem cell transplantation, pure red cell aplasia.Citation: Stussi G, Halter J, Bucheli E, Valli PV, Seebach L, Gmür J, Gratwohl A, Schanz U, Passweg JR, and Seebach JD. Prevention of pure red cell aplasia after major or bidirectional ABO blood group incompatible hematopoietic stem cell transplantation by pretransplant reduction of host anti-donor isoagglutinins. Haematologica 2009; 94:239-248. doi:10.3324/haematol.13356 ©2009 Ferrata Storti Foundation. This is an open-access paper.Prevention of pure red cell aplasia after major or bidirectional ABO blood group incompatible hematopoietic stem cell transplantation by pretransplant reduction of host anti-donor isoagglutinins

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Section: © F E R R a T A S T O R T I F O U N D A T I O Nmentioning

confidence: 99%

Prevention of pure red cell aplasia after major or bidirectional ABO blood group incompatible hematopoietic stem cell transplantation by pretransplant reduction of host anti-donor isoagglutinins

Stüssi¹,

Halter²,

Bucheli

et al. 2009

Haematologica

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“…Verholen et al 97 and Ebihara et al 98 described the successful treatment with repetitive doses of donor lymphocytes of two patients who failed previous treatments with changes in immunosuppressive treatment, high-dose EPO, plasma exchange and rituximab therapy. Lymphocyte infusions may result in the development of GvHD that may be more difficult to manage and of higher risk to the patient than continued transfusion support until eventual resolution of anti-donor isoagglutinins.…”

Section: Management Of Red Cell-incompatible Transplantsmentioning

confidence: 99%

Red blood cell-incompatible allogeneic hematopoietic progenitor cell transplantation

Rowley

Donato

Bhattacharyya

2011

Bone Marrow Transplant

121

104

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“…4,13,14 Some reports have noted that performing donor lymphocyte infusion and causing the graft-versus-plasma cell effect can conversely be effective in such cases. 4,15 In addition, some have reported the efficacy of plasma exchange or rituximab, and thus there is no single treatment strategy. 4 In the present case, PRCA went into spontaneous remission when the t a c r o l i m u s d o s a g e r e d u c t i o n w a s t e r m i n a t e d a n d administration was maintained at a low dosage.…”

Section: Case Reportmentioning

confidence: 99%

Pure red cell aplasia and Evans syndrome following hematopoietic stem cell transplantation from blood type-matched unrelated donor

Yamaguchi

Nakayama

Moriya

et al. 2012

Journal of Hematopoietic Cell Transplantation

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Pure red cell aplasia (PRCA) and Evans syndrome following allogeneic hematopoietic stem cell transplantation (HSCT) from a blood type-matched donor are very rare. A 29-year-old Japanese woman with hematologic remission of Philadelphia chromosomepositive acute lymphoblastic leukemia underwent bone marrow transplantation from a blood type-matched, HLA 6/6 matched, unrelated donor in May 2008. Her clinical course after transplantation was favorable, and allowed for a gradual reduction in tacrolimus dosage. However, 12 months after transplantation, she developed PRCA related to allogeneic HSCT. The patient s PRCA was alleviated by stopping the dosage reduction for the immunosuppressive therapy and by continued administration of lowdose tacrolimus. Three months after the PRCA diagnosis, the patient developed Evans syndrome, so prednisolone (PSL) treatment was initiated. PSL treatment effectively treated the Evans syndrome, as was evident by the absence of cythemolysis two months later, and no relapse has occurred even after the PSL dose was reduced and then terminated. The fact that PRCA onset in this case occurred after blood type-matched allogeneic HSCT, during the late grafting phase, and in combination with Evans syndrome, suggests that the pathogenic mechanism may differ from that of previously reported cases of PRCA following blood type-incompatible allogeneic HSCT. (Journal of Hematopoietic Cell Transplantation Vol. 1 No. 1; 24-28, 2012) BackgroundPure red cell aplasia (PRCA) and autoimmune hemolytic anemia (AIHA) are rare complications that follow allogeneic hematopoietic stem cell transplantation (HSCT).1 3 PRCA has occurred after blood type-mismatched allogeneic HSCT, in which case the remaining isohemagglutinin in the recipient plasma is thought to suppress erythropoiesis. 4 With regard to AIHA, continuous suppression of cellular immunity after allogeneic HSCT is thought to affect humoral immunity, yielding the production of autoantibodies which contribute to hemolysis. 2,5,6 Here we report a case of PRCA followed by Evans syndrome that developed after unrelated donor allogeneic HSCT from a blood type-matched, human leukocyte antigen (HLA) 6/6 matched donor. Case ReportThe patient was a 29 year-old Japanese woman without c a s e s ( 2 . 0 % ) o f p a n c r e a s t r a n s p l a n t a t i o n u s i n g immunosuppression with alemtuzumab, mycophenolate mofetil, and daclizumab. 10 One factor that may be involved in AIHA and Evans syndrome as well as PRCA is an immune abnormality brought about by excessive immunosuppression, but the causative mechanisms of this remain largely unknown.The case study did not use drugs such as ATG for the However, if this treatment does not yield improvement, administration of ATG or steroids, i. e., treatments that strengthen immunosuppression, can also be effective. 4,13,14 Some reports have noted that performing donor lymphocyte infusion and causing the graft-versus-plasma cell effect can conversely be effective in such cases. 4,15 In addition, some have reported the eff...

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Resistant pure red cell aplasia after allogeneic stem cell transplantation with major ABO mismatch treated by escalating dose donor leukocyte infusion

Cited by 44 publications

References 41 publications

Prevention of pure red cell aplasia after major or bidirectional ABO blood group incompatible hematopoietic stem cell transplantation by pretransplant reduction of host anti-donor isoagglutinins

Prevention of pure red cell aplasia after major or bidirectional ABO blood group incompatible hematopoietic stem cell transplantation by pretransplant reduction of host anti-donor isoagglutinins

Red blood cell-incompatible allogeneic hematopoietic progenitor cell transplantation

Pure red cell aplasia and Evans syndrome following hematopoietic stem cell transplantation from blood type-matched unrelated donor

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