Successful treatment of refractory pure red cell aplasia with bortezomib after allogeneic haematopoietic cell transplantation in a patient with alpha‐beta subcutaneous panniculitis‐like T cell lymphoma

Shahan, Jaime; Hildebrandt, Gerhard

doi:10.1111/tme.12216

Cited by 12 publications

(8 citation statements)

References 10 publications

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“…[40][41][42] But the most commonly used strategy is targeting B cells secreting IHA with an anti-CD20 monoclonal antibody (rituximab), [43][44][45][46][47] donor lymphocyte infusions (DLI) 16,18,48,49 or a proteasome inhibitor (bortezomib). [50][51][52] More recently, a strategy targeting plasma cells using an anti-CD38 monoclonal antibody has been reported, with promising results. Finally, for some authors, the tapering of immunosuppressive (IS) drugs is the first therapeutic measure against PRCA, in order to eradicate the last recipient cells that produce isohaemagglutinins by enhancing a graft-versus-plasma cell effect.…”

Section: Introductionmentioning

confidence: 99%

Treatment for pure red cell aplasia after major ABO‐incompatible allogeneic stem cell transplantation: a multicentre study

et al. 2021

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Pure red cell aplasia (PRCA) following allogeneic haematopoietic stem cell transplantation (aHSCT) with major ABO incompatibility is responsible for transfusion dependent anaemia, impaired quality of life and iron overload. We conducted a retrospective study, over a 10-year period, which included all consecutive patients who received a major ABO mismatched aHSCT, to assess the impact of specific treatment on PRCA. We did not observe any PRCA in the 57 aHSCT issued from cord blood. Among the remaining 631 patients, cumulative incidence of PRCA was 10Á5% [range 8Á2-13.0]. The median duration of resolved PRCA was 171 days [IQR 116; 261]. Pretransplant high isohaemagglutinins titre was associated with an increased risk of PRCA (P < 10 À4 ). PRCA did not affect overall survival (P = 0Á95). Twenty-two patients (33Á3%) received at least one specific treatment. The most commonly used treatments were rituximab (17 patients) and donor lymphocyte infusion (DLI; seven patients). Regarding PRCA resolution, we did not observe a significant difference between treated or untreated subjects (HR = 0Á93, 95% confidence interval (CI) 0Á48-1Á80; P = 0Á82). Similar results were observed with erythropoietin treatment (22 patients, HR = 0Á86 95% CI: [0Á47-1Á57] P = 0Á62). Our data do not support the use of erythropoietin, rituximab or DLI for the treatment of PRCA.

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Section: Introductionmentioning

confidence: 99%

Treatment for pure red cell aplasia after major ABO‐incompatible allogeneic stem cell transplantation: a multicentre study

et al. 2021

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“…This approach has been reported effective in several cases but poses the patient at a significant risk of developing GVHD, which can be a fatal complication (20). Other strategies use immunosuppressive agents, including highdose steroids, rituximab, bortezomib or daratumumab, in an attempt to suppress the production of anti-donor IHAs or employ antigen-unspecific apheresis modalities to remove circulating host IHAs (5)(6)(7)(8)(9)(10)(11)(12). Of the strategies mentioned above, the chimeric monoclonal anti-CD20 antibody rituximab is currently among the most widely applied with several reports indicating its efficacy (6,11).…”

Section: Discussionmentioning

confidence: 99%

“…Of the strategies mentioned above, the chimeric monoclonal anti-CD20 antibody rituximab is currently among the most widely applied with several reports indicating its efficacy (6,11). However, not all patients respond with a complete resolution of PRCA to its use (9)(10)(11). In addition, rituximab may cause infusion reactions and substantially increases the susceptibility to infections due to a long-lasting B-cell depletion (21).…”

Section: Discussionmentioning

confidence: 99%

“…Pure red cell aplasia occurs in up to 30% of all major ABO-incompatible HSCTs (4,5). Apart from supportive measures including the administration of erythropoietin-stimulating agents (ESAs), other therapeutic approaches for PRCA include the modulation of immunosuppression, administration of immunosuppressive agents, or apheresis modalities like high-volume plasmaexchange (PE) or semi-selective immunoadsorption (5)(6)(7)(8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

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Antigen-Specific Immunoadsorption With the Glycosorb® ABO Immunoadsorption System as a Novel Treatment Modality in Pure Red Cell Aplasia Following Major and Bidirectional ABO-Incompatible Allogeneic Hematopoietic Stem Cell Transplantation

et al. 2020

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Pure red cell aplasia (PRCA) after ABO-incompatible allogeneic hematopoietic stem cell transplantation (HSCT) is caused by persisting host-derived isohemagglutinins directed against donor red blood cell (RBC) antigens. ABO antigen-specific immunoadsorption (ABO-IA) with Glycosorb ® , commonly used for desensitization therapy in ABO-incompatible living donor renal transplantation, specifically eliminates circulating isohemagglutinins and might represent a novel treatment option for post-HSCT PRCA. In this prospective observational (n = 3) and retrospective (n = 3) analysis of six adult HSCT-recipients with PRCA, ABO-IA was initiated at 159 (range: 104-186) days following HSCT. The median treatment frequency was 4.5 (range: 3.9-5.5) sessions/week. ABO-IA-treatment led to a continuous decrease in isohemagglutinin titers. Reticulocytes increased to ≥30 G/L after 17.5 (range: 4-37) immunoadsorption sessions over 28.5 (range: 6-49) days and continued to rise after that. By the end of the 3-month follow-up period after discontinuation of ABO-IA, all patients showed a sustained remission of PRCA and were independent of erythropoietin-stimulating agents and transfusions. No case of infection or graft-versus-host disease was observed. After a median follow-up of 22.03 (range: 6.08-149.00) months after ABO-IA-treatment, all patients were alive and showed a stable RBC engraftment of the donor blood group. Our data provide the first evidence for ABO-IA as an effective treatment for post-HSCT PRCA.

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“…In some cases, rituximab, a monoclonal antibody against CD20 positive B lymphocytes, is used 29 . Bortezomib is a proteasome inhibitor that is usually used to treat plasma cell dyscrasias, and it can be used to treat PRCA after transplantation in patients with no response to different treatments such as immunosuppressive, corticosteroids and rituximab 30 .…”

Section: Introductionmentioning

confidence: 99%

ABO Blood Grouping Mismatch in Hematopoietic Stem Cell Transplantation and Clinical Guides

Shokrgozar

Tamaddon

2018

IJHOSCR

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Hematopoietic stem cell transplantation (HSCT) is a useful treatment. In contrast to solid organ transplantations, the use of ABO blood group mismatch is acceptable in HSCT. Immediate or late hemolytic reactions, pure red cell aplasia, delayed red blood cell recovery, and graft-versus -host disease are the results of this situation. This review shows the consequences of ABO-mismatched HSCT and its impacts on HSCT parameters, as well as providing clinical guides in this situation.

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Successful treatment of refractory pure red cell aplasia with bortezomib after allogeneic haematopoietic cell transplantation in a patient with alpha‐beta subcutaneous panniculitis‐like T cell lymphoma

Cited by 12 publications

References 10 publications

Treatment for pure red cell aplasia after major ABO‐incompatible allogeneic stem cell transplantation: a multicentre study

Treatment for pure red cell aplasia after major ABO‐incompatible allogeneic stem cell transplantation: a multicentre study

Antigen-Specific Immunoadsorption With the Glycosorb® ABO Immunoadsorption System as a Novel Treatment Modality in Pure Red Cell Aplasia Following Major and Bidirectional ABO-Incompatible Allogeneic Hematopoietic Stem Cell Transplantation

ABO Blood Grouping Mismatch in Hematopoietic Stem Cell Transplantation and Clinical Guides

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