Autoimmune neutropenia following peripheral blood stem cell transplantation

Abstract

The differential diagnosis of unexpected neutropenia following bone marrow transplantation includes several potentially life-threatening complications including graft rejection, overwhelming infection, relapse of the underlying neoplasm, and intrinsic graft failure. However, a number of recent reports document that the differential diagnosis also includes autoimmune neutropenia, which, although potentially life-threatening, often responds well to corticosteroids or splenectomy. Autoimmune neutropenia has been reported following both autologous and allogeneic bone marrow transplantation. Herein we report a 31-year-old woman who developed a rapidly falling neutrophil count 11 days following peripheral blood stem cell transplantation for non-Hodgkin's lymphoma. A laboratory evaluation supported a diagnosis of autoimmune neutropenia, and the neutropenia resolved following treatment with steroids and granulocyte-colony stimulating factor.

G-CSF-induced decrease of the anti-granulocyte autoantibody levels in a patient with autoimmune granulocytopenia

“…In summary, this report confirms isolated case reports that administration of G-CSF may be of benefit to patients with autoimmune granulocytopenia [2,6,13,14,19,20]. With respect to the G-CSF-related increase of the circulating granulocytes, two mechanisms seem to be involved in this patient.…”

“…The efficacy of immunomodulation such as the administration of corticosteroids, high-dose gammaglobulin, or splenectomy in primary and secondary AIN is unpredictable [1,2,3,19]. Unexpectedly, recent case reports have revealed a therapeutic role for the hematopoietic growth factors in patients with AIN [8,13,[18][19][20]. Both granulocyte-macrophage colony-stimulating factor (GM-CSF) and granulocyte colony-stimulating factor (G-CSF) have been successfully applied in patients with AIN associated with the Felty's syndrome [2,10], systemic lupus erythematosus [6], and a variety of other conditions [8,13,[18][19][20].…”

“…Unexpectedly, recent case reports have revealed a therapeutic role for the hematopoietic growth factors in patients with AIN [8,13,[18][19][20]. Both granulocyte-macrophage colony-stimulating factor (GM-CSF) and granulocyte colony-stimulating factor (G-CSF) have been successfully applied in patients with AIN associated with the Felty's syndrome [2,10], systemic lupus erythematosus [6], and a variety of other conditions [8,13,[18][19][20]. In one report of a child with chronic AIN, treatment with G-CSF, instituted 2 weeks after the start of prednisone, led to an increase of the circulating granulocytes with the disappearance of the anti-granulocyte antibodies [14].…”

Ulcerative colitis after autologous peripheral blood stem cell transplantation for non-Hodgkin's lymphoma

“…1 autoimmune neutropenia, 2 and autoimmune thyroiditis 3 may develop following autologous, as well as allogeneic, hematopoietic stem cell transplantation (HSCT). These may develop via an immune system imbalance due to insufficient numbers or inadequate function of suppressor T cells in the early post-graft period, delayed recovery of regulatory T cells, or subsequent reactivation of autoreactive T cells.…”

Autoimmune thrombocytopenic purpura after autologous stem cell transplantation

“…The same immunological mechanisms are suspected during autoimmune reactions and after induction of autologous GVHD. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Finally, the lack of lymphoma relapse in the present series, despite the poor prognostic characteristics of those patients, may suggest that a graft-versus-lymphoma effect could be associated with the occurrence of autoimmune events after transplantation. The contribution of autoimmune events in maintaining disease control after ASCT has been previously suspected.…”