Successful Treatment of Pure Red Cell Aplasia with Rituximab in Patients after ABO-Compatible Allogeneic Hematopoietic Stem Cell Transplantation

Jung, Sung-Hoon; Ahn, Jae‐Sook; Yang, Deok‐Hwan; Park, Hyung Chul; Bae, Soo-Young; Kim, Yeo-Kyeoung; Kim, Hyeoung-Joon; Lee, Je‐Jung

doi:10.1159/000337022

Cited by 7 publications

(5 citation statements)

References 15 publications

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“…In our study, 3 patients with PRABO expressed more traditional signs associated with pure red cell aplasia. Pure red cell aplasia after HSCT is associated with major ABO incompatibility between donor and recipient [20,50]. Treatments with rituximab, donor plasma exchange, and donor lymphocyte infusions have been tried successfully at other centers [51][52][53].…”

Section: Discussionmentioning

confidence: 99%

Analysis of Donor and Recipient ABO Incompatibility and Antibody-Associated Complications after Allogeneic Stem Cell Transplantation with Reduced-Intensity Conditioning

Watz

Remberger

Ringdén

et al. 2014

Biology of Blood and Marrow Transplantation

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Allogeneic hematopoietic stem cell transplantation (HSCT) can be performed across the ABO blood group barrier. The impact of ABO incompatibility on clinical outcome is controversial. A retrospective analysis of 310 patients who underwent HSCT with reduced-intensity conditioning between 1998 and 2011 was performed to investigate the frequency and clinical implications of anti-RBC antibodies in passenger lymphocyte syndrome (PLS) after minor ABO mismatch (mm), persistent or recurring recipient type ABO antibodies (PRABO) after major ABO mm HSCT, and autoimmune hemolytic anemia (AIHA). Transplantation characteristics and clinical outcome were analyzed by univariate and multivariate analysis for groups with or without anti-RBC antibodies. ABO blood group incompatibility did not affect clinical outcome despite an increased requirement of blood transfusion. Twelve patients with AIHA, 6 patients with PLS, and 12 patients with PRABO post-HSCT were identified. AIHA did not affect overall survival (OS) or transplant-related mortality (TRM), but patients with AIHA had a lower incidence of grades II to IV acute graft-versus-host disease (P = .05). OS in the PLS group was 0% compared with 61% in the whole group receiving minor ABO mm transplants (P < .001). Comparing PRABO patients with those receiving a major ABO mm HSCT, the OS was 17% versus 73% (P = .002) and TRM was 50% versus 21% (P = .03). At our center, PLS after minor ABO mm and PRABO antibodies after major ABO mm HSCT are significant risk factors for decreased OS and TRM. Our results suggest that occurrence of unexpected ABO antibodies after HSCT warrant a wider investigation individual to find the underlying cause.

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Section: Discussionmentioning

confidence: 99%

Analysis of Donor and Recipient ABO Incompatibility and Antibody-Associated Complications after Allogeneic Stem Cell Transplantation with Reduced-Intensity Conditioning

Watz

Remberger

Ringdén

et al. 2014

Biology of Blood and Marrow Transplantation

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“…Rituximab is a genetically engineered monoclonal antibody directed against CD20 antigen, is seen in a certain subset of B-cells, and causes significant B-cell depletion. Rituximab has shown good efficacy in many autoimmune hematologic disorders together with low or absent toxicity ( 13 , 14 ) and has already been administered in other cases of PRCA ( 15 , 16 ). Cases of epoetin-related PRCA treated with rituximab which succeeded or failed had been reported ( 17 , 18 ).…”

Section: Introductionmentioning

confidence: 99%

Case Report: Roxadustat in Combination With Rituximab Was Used to Treat EPO-Induced Pure Red Cell Aplasia

You¹,

Guo²,

Wang³

et al. 2022

Front. Nephrol.

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Recombinant human erythropoietin (rHuEPO) is a drug given to patients who have low hemoglobin related to chronic kidney disease or other anemia-related diseases. Some patients who receive rHuEPO repeatedly develop anti-rHuEPO-neutralizing antibodies, leading to the occurrence of pure red cell aplasia (PRCA). PRCA associated with rHuEPO includes severe rHuEPO resistance, blood transfusion dependence, high serum ferritin, severe reticulocytopenia, and presence of anti-rHuEPO antibody. However, the optimal treatment of erythropoietin (EPO)-induced PRCA is unclear. Therapeutic options against it remain a major clinical challenge. Herein we report on 2 male patients with PRCA during rHuEPO treatment, who received a combination therapy of roxadustat plus rituximab but had completely different clinical outcomes. The results obtained in this study show that roxadustat in combination with rituximab could be one of the treatment options for EPO-induced PRCA, but the treatment efficacy can vary from one individual to another. Additionally, we recommend starting reticulocyte monitoring and immunosuppressive agent therapy as early as possible to shorten the course of the disease and improve the outcomes of the patients.

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“…1,4 Pure red cell aplasia (PRCA) is a rare disorder, induced by gene mutations present at birth; infectious diseases such as parvovirus B19, Epstein-Barr virus, or hepatitis; immunologic disorders such as autoimmune disorders or tumor-associated disorders; or drugs such as chloramphenicol or azathioprine. [7][8][9] However, PRCA associated with LZD therapy has been reported in only seven patients. [10][11][12][13][14] PRCA can lead to anemia, decreased reticulocytes (to less than 1%), and decreased erythroid lineage cells at various stages, especially erythroid precursor cells.…”

Section: Introductionmentioning

confidence: 99%

Linezolid-induced pure red cell aplasia: a case report and literature review

Luo

Wang

et al. 2018

J Int Med Res

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Linezolid (LZD) is the first oxazolidinone with excellent safety and efficacy profiles against refractory infections caused by gram-positive organisms. Hematological toxicities such as thrombocytopenia, anemia, and leukocytopenia are common in LZD therapy; however, LZD-induced pure red cell aplasia (PRCA) is rare. An 83-year-old man diagnosed with pleural empyema caused by Staphylococcus aureus received LZD after developing resistance to multiple antibiotics. Although his infection-related symptoms were improved by LZD, progressive anemia was noticed after LZD therapy was initiated. Eight weeks after LZD administration began, his hemoglobin level was 5.7 g/dL and reticulocyte proportion was 0.36%, while his white blood cell and platelet counts remained unchanged since admission. Bone marrow examination revealed markedly decreased erythropoiesis with cytoplasmic vacuolation of erythroblasts. Anemia resolved by 14 days after cessation of LZD. It is important to increase the awareness among clinicians about the potential for the hematological effects associated with LZD, particularly for older patients with pre-existing anemia and treatment courses longer than 14 days. To detect bone marrow suppression, including PRCA, we suggest monitoring the complete blood count and reticulocyte count periodically in patients receiving long-term LZD therapy.

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Successful Treatment of Pure Red Cell Aplasia with Rituximab in Patients after ABO-Compatible Allogeneic Hematopoietic Stem Cell Transplantation

Cited by 7 publications

References 15 publications

Analysis of Donor and Recipient ABO Incompatibility and Antibody-Associated Complications after Allogeneic Stem Cell Transplantation with Reduced-Intensity Conditioning

Analysis of Donor and Recipient ABO Incompatibility and Antibody-Associated Complications after Allogeneic Stem Cell Transplantation with Reduced-Intensity Conditioning

Case Report: Roxadustat in Combination With Rituximab Was Used to Treat EPO-Induced Pure Red Cell Aplasia

Linezolid-induced pure red cell aplasia: a case report and literature review

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