Response to high-dose dexamethasone for acquired pure red cell aplasia following ABO-mismatched allogeneic stem cell transplantation

Deotare, Uday; Vishwabandya, Auro; George, Biju; Srivastava, Alok; Chandy, Mammen

doi:10.1038/sj.bmt.1705378

Cited by 13 publications

(16 citation statements)

References 9 publications

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“…48,49 If this strategy is not successful, several other strategies have been proposed according to the pathophysiology of the disorder: plasmapheresis, 43,46,64 antithymocyte globulin, 38,41 erythropoietin, 39,42,44,61 corticosteroids, 53,56 rituximab, 47,54 and donorlymphocyte infusions to induce GvHD. 45,51 Virtually all of these treatments have only been evaluated in a few patients or in single case reports.…”

Section: © F E R R a T A S T O R T I F O U N D A T I O Nmentioning

confidence: 99%

Prevention of pure red cell aplasia after major or bidirectional ABO blood group incompatible hematopoietic stem cell transplantation by pretransplant reduction of host anti-donor isoagglutinins

Stüssi¹,

Halter²,

Bucheli

et al. 2009

Haematologica

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BackgroundPersistent anti-donor isoagglutinins after major ABO blood group incompatible hematopoietic stem cell transplantation may cause delayed red blood cell engraftment and post-transplant pure red cell aplasia. Design and MethodsWe investigated the effect of pretransplant anti-donor isoagglutinin reduction by in vivo absorption and/or plasmapheresis on the incidence of pure red cell aplasia and the time to red blood cell engraftment in 153 hematopoietic stem cell transplant recipients with major ABO incompatibility. ResultsTwelve patients (8%) developed pure red cell aplasia, 3/98 (3%) with, and 9/55 (16%) without prior isoagglutinin reduction (p=0.009). Red blood cell engraftment was faster in patients with isoagglutinin reduction; in addition, peripheral blood hematopoietic stem cell transplantation, acute graft-versus-host disease, and younger age were associated with faster red blood cell engraftment in Cox regression analysis. In patients with pure red cell aplasia the mean red blood cell engraftment occurred after 225 days (p<0.001) and was associated with a simultaneous decrease of anti-donor isoagglutinins. Patients with pure red cell aplasia had higher pretransplant anti-donor isoagglutinin titers (p=0.001) and received more post-transplant red blood cell transfusions (p<0.001). ConclusionsFollowing major ABO incompatible hematopoietic stem cell transplantation, pure red cell aplasia and delayed red blood cell engraftment depend on the levels of anti-donor isoagglutinins and are efficiently prevented by the pretransplant removal of these isoagglutinins. The benefits of reducing the time of transfusion-dependency and transfusion-associated risks must be carefully balanced against the potential side effects of isoagglutinin reduction.Key words: ABO blood group incompatibility, allogeneic hematopoietic stem cell transplantation, pure red cell aplasia.Citation: Stussi G, Halter J, Bucheli E, Valli PV, Seebach L, Gmür J, Gratwohl A, Schanz U, Passweg JR, and Seebach JD. Prevention of pure red cell aplasia after major or bidirectional ABO blood group incompatible hematopoietic stem cell transplantation by pretransplant reduction of host anti-donor isoagglutinins. Haematologica 2009; 94:239-248. doi:10.3324/haematol.13356 ©2009 Ferrata Storti Foundation. This is an open-access paper.Prevention of pure red cell aplasia after major or bidirectional ABO blood group incompatible hematopoietic stem cell transplantation by pretransplant reduction of host anti-donor isoagglutinins

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Section: © F E R R a T A S T O R T I F O U N D A T I O Nmentioning

confidence: 99%

Prevention of pure red cell aplasia after major or bidirectional ABO blood group incompatible hematopoietic stem cell transplantation by pretransplant reduction of host anti-donor isoagglutinins

Stüssi¹,

Halter²,

Bucheli

et al. 2009

Haematologica

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“…PRCA following allogeneic HSCT has been mostly reported in situations involving major ABO incompatibility between donor and recipient [3, 4], with the exception of one case following major ABO-matched allogeneic HSCT [5]. 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].…”

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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“…It has been proposed that the antibodies against donor RBC secreted by residual recipient B cells or plasma cells might be responsible, and particularly when the donor blood type is A (because of the high affinity between A antigens and anti-A antibodies, and the higher expression density of A antigens on the cell surface than B) (Lee et al, 2000). A number of treatment modalities have been tried for PRCA (Rowley et al, 2011), including steroids (Yang & Hsu, 2001;Deotare et al, 2006), EPO, plasmapheresis, immunoadsorption, donor lymphocyte infusion (DLI), rituximab and bortezomib (Khan et al, 2014).…”

Section: Dear Sirmentioning

confidence: 99%

“…There have been relatively few cases reported in the literature in which high-dose steroids have been used as monotherapy to treat both idiopathic PRCA (Ozsoylu, 1990) and ABO-incompatible-HSCT-related PRCA (Yang & Hsu, 2001;Deotare et al, 2006). In one case report of post-transplant PRCA, the authors claimed that adequate dosage and duration of prednisolone were essential in eliciting a meaningful clinical response (Yang & Hsu, 2001).…”

Section: Dear Sirmentioning

confidence: 99%

Pulsed‐high‐dose dexamethasone as a treatment for pure red cell aplasia following ABO‐incompatible allogeneic stem cell transplantation

Yang

Levis

2014

Transfusion Medicine

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Response to high-dose dexamethasone for acquired pure red cell aplasia following ABO-mismatched allogeneic stem cell transplantation

Cited by 13 publications

References 9 publications

Prevention of pure red cell aplasia after major or bidirectional ABO blood group incompatible hematopoietic stem cell transplantation by pretransplant reduction of host anti-donor isoagglutinins

Prevention of pure red cell aplasia after major or bidirectional ABO blood group incompatible hematopoietic stem cell transplantation by pretransplant reduction of host anti-donor isoagglutinins

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

Pulsed‐high‐dose dexamethasone as a treatment for pure red cell aplasia following ABO‐incompatible allogeneic stem cell transplantation

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