Autoimmune hematological diseases following haploidentical donor hematopoietic stem cell transplant compared with matched sibling and unrelated donor

Abstract

Autoimmune hematological diseases (AHDs) occur more frequently than other autoimmune complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and are often refractory to treatment. This study was to analyze the incidence and risk factors of AHDs as well as their response to treatment. Four hundred and forty-five adult malignant hematopoietic disorders underwent allo-HSCT were enrolled in this retrospective study, including 124 haploidentical donor (HRD), 140 unrelated donor (MUD) and 181 HLA-matched sibling donor (MSD) transplants. Twelve patients developed AHDs, including 6 autoimmune hemolytic anemia and 6 Evans syndrome. Evans syndrome all occurred in HRD transplants. The 3-year cumulative incidence of AHDs was 4.0 ± 1.3%, and HRD had higher incidence than MUD (8.7 ± 3.0% vs 1.8 ± 1.2%, P = 0.012) and MSD (8.7 ± 3.0% vs 3.5 ± 2.6%, P = 0.004 ). The steroids combined with Cyclosporine A were acted as the first line treatment, and the response rate was 73%. No patients experienced recurrence at a median follow up of 313 days after stopping treatment. HRD transplants (vs MUD: HR, 5.87; CI, 1.24 to 27.73; p = 0.026 and vs MSD: HR, 7.70; CI, 1.63 to 36.44; P = 0.010) and concurrent chronic graft versus host disease (HR, 3.76; CI, 1.18 to 11.92; P = 0.025) were risk factors for AHDs.

Autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation in adults: A southern China multicenter experience

“…High‐resolution molecular techniques were used to detect HLA typing of recipients and donors . All patients received myeloablative conditioning regimens.…”

“…Responses were mainly evaluated at 4 and 12 weeks after initial treatment. Thresholds for determining response were based on standard and previous studied outcome criteria for AIHA and Evans syndrome . The criteria for effectiveness were as follows: (a) CR: Hb level of 12 g/dL and a platelet (PLT) level of 100 g/L or more in the absence of a transfusion without features of hemolysis (normal bilirubin and lactate dehydrogenase levels ± normal haptoglobin level if performed); (b) partial response (PR): Hb level of at least 10 g/dL with an increase of at least 2 g from baseline and a PLT level of at least 50 g/L; (c) NR: failure to meet the above two criteria; and (d) the overall response (OR) rate included both CR and PR.…”

“…[1][2][3][4][5][6][7][8] Autoimmune hematological diseases may affect a single lineage of blood cells, for example, autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP), or 2 and/or 3 lineages, for example, Evans syndrome. In these AHDs, AIHA is the most common with estimates of the incidence between 2% and 6% 7,[9][10][11] in recipients of allo-HSCT. AIHA posttransplants have been proved to be associated with many factors, such as human leukocyte antigen (HLA)-mismatched transplants, chronic graft vs host disease (cGVHD), using antithymocyte globulin (ATG), and so on.…”

Autoimmune hemolytic anemia and immune thrombocytopenia following hematopoietic stem cell transplant: A critical review of the literature

“…An additional study showed no imbalance between T‐ and B‐cell reconstitution at 90 and 180 days following HSCT in patients who developed AIC. In this study, T‐ and B‐cell profiles at the time of AIC formation were not known . Therefore, the role of Treg and T/B‐cell imbalance in post‐ HSCT AIC warrants further study.…”

“…One article was excluded because it did not mention immune cytopenia complications. This resulted in 22 primary evaluable articles …”