Red cell aplasia and autoimmune hemolytic anemia following immunosuppression with alemtuzumab, mycophenolate, and daclizumab in pancreas transplant recipients

Elimelakh, Milena; Dayton, Vanessa; Park, Katharine S.; Gruessner, Angelika C.; Sutherland, David E.R.; Howe, Robert B.; Reding, Mark T.; Eastlund, Ted; Burik, Jo Anne Van; Singleton, Timothy P.; Gruessner, Rainer W.G.; Key, Nigel S.

doi:10.3324/haematol.10733

Cited by 56 publications

(50 citation statements)

References 40 publications

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“…Julien Zuber, 1,5 Kheira Beldjord, 2,5 Nicole Casadevall, 3 Eric Thervet, 1,5 Christophe Legendre, 1,5 …”

Section: Immune-mediated Pure Red Cell Aplasia In Renal Transplant Reunclassified

“…11 The role of CNI in controlling self-reactive clones in transplanted patients is further supported by a recent report that 20 out of 357 (5.6%) pancreas transplant recipients experienced immune-mediated cytopenia while receiving a calcineurin inhibitor-free regimen. 5 The high frequency of autoimmune cytopenia in this series is striking and may be related to lymphopenic induction by alemtuzumab, which has already been associated with increased autoimmune thyroid disease in renal transplant recipients. 12 Mechanisms of lymphopenia-induced autoimmunity are well described and it is likely that calcineurin inhibitors may be critical to control the expansion of pathogenic self-reactive clones in this setting.…”

Section: Immune-mediated Pure Red Cell Aplasia In Renal Transplant Rementioning

confidence: 99%

“…This hypothesis is supported by an unexpectedly high frequency of LGL-like clonal disorders in organ transplant recipients, 4 and by a recent report of autoimmune cytopenia occurring in up to 5.6% of pancreas transplant recipients receiving a calcineurin inhibitor-free regimen. 5 We report here 3 renal transplant recipients admitted for PRCA, in whom thorough investigations provided compelling evidence of immune mechanisms. End stage renal failure was related to chronic primary glomerulonephritis in all of them, and they all received a first renal transplant in the early '80s.…”

Section: Immune-mediated Pure Red Cell Aplasia In Renal Transplant Rementioning

confidence: 99%

“…Whereas some HPP patients are compound heterozygotes or homozygotes for missense mutations in spectrin, others are heterozygotes for a missense mutation and possess a second, thalassemia-like α-spectrin allele in trans to the missense mutation. [4][5][6] This productiondefective allele is associated with decreased or absent accumulation of α-spectrin on the erythrocyte membrane. With the exception of the original case described by Zarkowsky et al, the molecular basis of the production-defective α-spectrin allele in HPP is unknown.…”

Section: Nonsense Mutations Of the α α-Spectrin Gene In Hereditary Pymentioning

confidence: 99%

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Immune-mediated pure red cell aplasia in renal transplant recipients

Beldjord¹,

Casadevall²,

Thervet³

et al. 2008

Haematologica

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“…Julien Zuber, 1,5 Kheira Beldjord, 2,5 Nicole Casadevall, 3 Eric Thervet, 1,5 Christophe Legendre, 1,5 …”

Section: Immune-mediated Pure Red Cell Aplasia In Renal Transplant Reunclassified

Section: Immune-mediated Pure Red Cell Aplasia In Renal Transplant Rementioning

confidence: 99%

Section: Immune-mediated Pure Red Cell Aplasia In Renal Transplant Rementioning

confidence: 99%

Section: Nonsense Mutations Of the α α-Spectrin Gene In Hereditary Pymentioning

confidence: 99%

See 2 more Smart Citations

Immune-mediated pure red cell aplasia in renal transplant recipients

Beldjord¹,

Casadevall²,

Thervet³

et al. 2008

Haematologica

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“…1 There have been reports of PRCA after immune suppression with tacrolimus and mycophenolate mofetil in transplanted patients. [2][3][4] We present a deceased-donor renal transplant patient who developed PRCA, which was caused by either mycophenolate mofetil or tacrolimus and treated with cyclosporine.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Pure Red-Cell Aplasia With Cyclosporine in a Renal Transplant Patient

Yildirim¹,

Bilen²,

Keleş³

et al. 2012

Exp Clin Transplant

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Acquired pure red-cell aplasia is a rare disorder that can be either idiopathic or associated with certain autoimmune diseases, pregnancy, lymphoproliferative disorders, nutritional deficiencies, or medicines. We present a deceased-donor renal transplant patient who developed pure red-cell aplasia associated with mycophenolate mofetil or tacrolimus and was treated with cyclosporine. A 20-year-old woman was transplanted from a deceased donor 1 month earlier and presented to us with symptoms of fatigue, prostration, and palpitation. The results of a laboratory examination revealed anemia. A diagnostic work-up resulted in a diagnosis of pure red-cell aplasia. Mycophenolate mofetil was discontinued. Tacrolimus also was replaced with cyclosporine 2 months after mycophenolate mofetil was halted because of a lack of improvement in anemia. Three months later, her anemia improved with cyclosporine. Starting cyclosporine instead of tacrolimus or mycophenolate mofetil showed good improvement in our patient within 6 months of therapy.

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Opportunistic infections and other risks with newer multiple sclerosis therapies

Berger

Houff

2009

Annals of Neurology

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The introduction of newer therapies for the treatment of multiple sclerosis has generated considerable optimism. That optimism has been tempered by the potential risks of these therapies, such as the risk for progressive multifocal leukoencephalopathy. A review of the possible causes of reactivation of JC virus in this population has illustrated the need to better understand the untoward effects of monoclonal antibody therapies and other immunomodulatory therapies currently being contemplated for use in multiple sclerosis. These drugs alter the immune response at different sites, and most, if not all, affect more than one aspect of host immunity. Drawing from existing experience with the use of these immunomodulatory therapies in other conditions and that available from the limited experience with multiple sclerosis, we review their potential untoward effects. The latter include a predisposition to opportunistic and community-acquired infections, an altered response to vaccination, the development of cancers, and the appearance of autoimmune diseases. The identification of progressive multifocal leukoencephalopathy as a risk of therapy is relatively straightforward in light of its rarity and high morbidity and mortality, but a relatively slight increased risk for more common and less disabling disorders may be overlooked. Determining the actual risk frequency for many of these complications will likely require careful postmarketing surveillance.

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Red cell aplasia and autoimmune hemolytic anemia following immunosuppression with alemtuzumab, mycophenolate, and daclizumab in pancreas transplant recipients

Cited by 56 publications

References 40 publications

Immune-mediated pure red cell aplasia in renal transplant recipients

Immune-mediated pure red cell aplasia in renal transplant recipients

Treatment of Pure Red-Cell Aplasia With Cyclosporine in a Renal Transplant Patient

Opportunistic infections and other risks with newer multiple sclerosis therapies

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