Severe Hemolysis Due to Passenger Lymphocyte Syndrome After Hematopoietic Stem Cell Transplantation From an HLA-Matched Related Donor

Reed, Maria A. B.; Yearsley, Martha; Krugh, Dave; Kennedy, Melanie S.

doi:10.5858/2003-127-1366-shdtpl

Cited by 18 publications

(2 citation statements)

References 8 publications

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“…ABO mismatched allo-HCT is usually known for its association with complications such as acute hemolysis, delayed engraftment, pure red cell aplasia, and passenger lymphocyte syndrome due to immune-mediated and non-immune-mediated mechanisms. [14][15][16] However, the significant association between ABO mismatch and outcomes such as survival, non-relapse mortality, and platelet engraftment seen in our study highlight its widespread effects and importance while selecting donors in the context of AML and ALL.…”

Section: Discussionmentioning

confidence: 70%

Association of ABO mismatch with the outcomes of allogeneic hematopoietic cell transplantation for acute leukemia

et al. 2023

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Allogeneic hematopoietic cell transplantation (allo‐HCT) is a potentially curative treatment for acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). While many factors influence the outcomes of allo‐HCT, the independent impact of donor–recipient ABO mismatching remains unclear. Using the Center for International Blood and Marrow Transplant Research (CIBMTR) database, we identified patients aged ≥18 years with AML or ALL who underwent allo‐HCT between 2008 and 2018. Our objectives were to analyze the outcomes of allo‐HCT based on the donor–recipient ABO status (match, minor mismatch, major mismatch, bidirectional mismatch). Among 4946 eligible patients, 2741 patients (55.4%) were ABO matched, 1030 patients (20.8%) had a minor ABO mismatch, 899 patients (18.1%) had a major ABO mismatch, and 276 patients (5.6%) had a bidirectional ABO mismatch. In multivariable analyses, compared to ABO matched allo‐HCT, the presence of a major ABO mismatch was associated with worse overall survival (HR 1.16, 95% CI 1.05–1.29; p = 0.005), inferior platelet engraftment (HR 0.83, 95% CI 0.77–0.90; p < 0.001), and higher primary graft failure (HR 1.60, 95% CI 1.12–2.30, p = 0.01). Relapse, acute graft versus host disease (GVHD) grades III‐IV and chronic GVHD were not significantly associated with ABO status. While donor age was not significantly associated with outcomes, older recipient age was associated with worse survival and non‐relapse mortality. Our study demonstrates that donor–recipient ABO status is independently associated with survival and other post‐transplantation outcomes in acute leukemia. This underscores the importance of considering the ABO status in donor selection algorithms and its impact in acute leukemia.

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Section: Discussionmentioning

confidence: 70%

Association of ABO mismatch with the outcomes of allogeneic hematopoietic cell transplantation for acute leukemia

et al. 2023

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“…To our knowledge, this combination of immunologic complications has not been reported in the literature to date. Instead, there are case reports of patients who developed one [6][7][8][9][10] or the other [11][12][13][14] following HSCT.…”

Section: Discussionmentioning

confidence: 99%

Passenger Lymphocyte Syndrome and Autoimmune Hypothyroidism Following Hematopoietic Stem Cell Transplantation

Noubouossié

Zaanona

Costa

et al. 2022

Case Reports in Immunology

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We present the case of a 24-year-old male, who received a minor ABO-incompatible allogeneic hematopoietic stem cell transplant (HSCT, blood group O+ ⟶ A+) from an HLA-matched unrelated female donor, as consolidation therapy for relapsed precursor-B-cell acute lymphoblastic leukemia. The donor had a known history of Hashimoto’s thyroiditis before HSCT. At day +10 posttransplant, the patient developed severe hemolysis, which required emergent red blood cell exchange. Additionally, about a year posttransplant, he had circulating antithyroglobulin antibodies, decreased free-T4 (fT4) and increased serum thyroid-stimulating hormone (TSH). The potential causes of the posttransplant hemolytic episode and hypothyroidism are discussed. While the hemolysis was worsened by the transfusion of A red blood cells (RBCs) in the context of passenger lymphocyte syndrome, the thyroid dysfunction might be explained by an autoimmune disease transferred from the donor. The case highlights the possibility of several non-relapse-related complications of HSCT occurring in the same patient. It is critical that such adverse outcomes are distinguished from classical graft-versus-host disease (GVHD) for adequate recipient counseling, posttransplant screening, and prompt treatment.

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Transfusion Therapy in Specific Clinical Situations

2016

Transfusion Medicine

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Severe Hemolysis Due to Passenger Lymphocyte Syndrome After Hematopoietic Stem Cell Transplantation From an HLA-Matched Related Donor

Cited by 18 publications

References 8 publications

Association of ABO mismatch with the outcomes of allogeneic hematopoietic cell transplantation for acute leukemia

Association of ABO mismatch with the outcomes of allogeneic hematopoietic cell transplantation for acute leukemia

Passenger Lymphocyte Syndrome and Autoimmune Hypothyroidism Following Hematopoietic Stem Cell Transplantation

Transfusion Therapy in Specific Clinical Situations

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