Treatment of pure red cell aplasia after major ABO-incompatible bone marrow transplantation with recombinant erythropoietin [letter; comment]

Heyll, A.; Aul, Carlo; Runde, Volker; Arning, M.; Schneider, W; Wernet, Peter

doi:10.1182/blood.v77.4.906.906

Cited by 38 publications

(6 citation statements)

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“…11,23,24 Many different therapeutics have been reported in the literature, mainly in case reports or small retrospective studies. Some treatments aimed to enhance medullar erythropoiesis as recombinant erythropoietin (rhEPO) [25][26][27] and thrombopoietin receptor agonist, 28 or to remove the residual IHA from the periphery (plasmapheresis or immunoadsorption 19,[29][30][31][32][33][34][35][36] ), while immunomodulatory strategies have also been used, such as corticosteroids [37][38][39] and mesenchymal stem cell infusions. [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).…”

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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“…PRCA following ABO-incompatible allogeneic HSCT is associated with an interaction of recipient anti-A or anti-B isoagglutinins with donor erythroid precursors expressing A and/or B antigens [ 6 ]. Spontaneous remission has been noted but treatments such as plasma exchange, donor-derived leukocyte infusion, erythropoietin, and steroids may be necessary to avoid RBC transfusion and to decrease the risk of hemochromatosis [ 7 , 8 , 9 , 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2012

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Pure red cell aplasia (PRCA) following allogeneic hematopoietic stem cell transplantation (HSCT) has been mostly reported in situations involving major ABO incompatibility between donor and recipient. Conventional treatments such as plasma exchange, erythropoietin, and steroid are often unsatisfactory. Rituximab has been reported to be highly effective for PRCA following major ABO-incompatible allogeneic HSCT. A 49-year-old woman with PRCA following ABO-matched allogeneic HSCT for acute lymphoblastic leukemia, refractory to erythropoietin treatment, received 4 doses of rituximab 375 mg/m² weekly. After the 3rd dose of rituximab, she exhibited a striking rise in her reticulocyte count with an increase in her hemoglobin level. To our knowledge, this is the first case of PRCA following major ABO-compatible allogeneic HSCT resolving completely after rituximab treatment.

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“…Several therapeutic approaches, including the administration of rhEPO [5,101,, and antilymphocyte globulin [7] as well as plasmapheresis [9], have been reported to be effective in this setting. RhEPO stimulates the bone marrow to produce excess numbers of erythroid precursors.…”

Section: Discussionmentioning

confidence: 99%

“…The delay is assumed to be caused by the persistence of host-derived antibodies targeting erythrocyte antigens on late-stage erythroid precursors [2]. There have been a few reports of the spontaneous recovery of erythrocytes; in other cases, patients have required a variety of clinical interventions [5,[7][8][9][10]. Recently, Hey11 et al [5] reported a patient with PRCA after major ABO-incompatible BMT who was successfully treated with recombinant human erythropoietin (rhEPO).…”

Section: Introductionmentioning

confidence: 99%

“…There have been a few reports of the spontaneous recovery of erythrocytes; in other cases, patients have required a variety of clinical interventions [5,[7][8][9][10]. Recently, Hey11 et al [5] reported a patient with PRCA after major ABO-incompatible BMT who was successfully treated with recombinant human erythropoietin (rhEPO). We describe two patients with PRCA following ABO-incompatible BMT, one who responded to rhEPO, and a second who developed massive hemolysis following rhEPO and methylprednisolone (m-PSL).…”

Section: Introductionmentioning

confidence: 99%

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Pure red cell aplasia after major ABO-incompatible bone marrow transplantation: two case reports of treatment with recombinant human erythropoietin

et al. 1996

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A 34-year-old man with acute myelocytic leukemia (AML: MO) and a 32-year-old woman with AML: M2 developed pure red cell aplasia (PRCA) after receiving a major ABO incompatible bone marrow transplant (BMT). The first patient responded to recombinant human erythropoietin (rhEPO) therapy, while the second did not. The second patient also received methylprednisolone (m-PSL) but developed reticulocytosis and hemolysis after the administration of m-PSL. Plasmapheresis was then performed and the patient promptly recovered from hemolysis and PRCA. We conclude that close attention must be paid when treating PRCA following major ABO-incompatible BMT with rhEPO and m-PSL, as there is always the potential for massive hemolysis.

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Treatment of pure red cell aplasia after major ABO-incompatible bone marrow transplantation with recombinant erythropoietin [letter; comment]

Cited by 38 publications

References 0 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

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

Pure red cell aplasia after major ABO-incompatible bone marrow transplantation: two case reports of treatment with recombinant human erythropoietin

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