Rituximab is effective in the management of refractory autoimmune cytopenias occurring after allogeneic stem cell transplantation

Abstract

Summary:Autoimmune haemolytic anaemia (AIHA), immune thrombocytopenia (ITP) and autoimmune neutropenia (AIN) are well-recognised complications of allogeneic stem cell transplantation (SCT), but have previously only been reported in the context of myeloablative conditioning regimens. Management of AIHA, ITP or AIN occurring after allogeneic SCT is unsatisfactory since they frequently prove refractory to conventional therapies including splenectomy. As a consequence, autoimmune cytopenias occurring after allogeneic SCT are associated with substantial morbidity and mortality. We report four patients who developed AIHA or ITP after allogeneic transplantation -three of which occurred after a reducedintensity conditioning (RIC) regimen. All patients demonstrated a complete response to Rituximab, having failed to respond to conventional treatment including high-dose prednisolone and intravenous immunoglobulin (IVIg). We conclude that Rituximab can be a valuable agent in the management of autoimmune cytopenias occurring after allogeneic SCT and that autoimmune cytopenias may be a hitherto unrecognised complication of RIC regimens.

Development of a secondary autoimmune disorder after hematopoietic stem cell transplantation for autoimmune diseases: role of conditioning regimen used

“…All our patients required multiple agents to treat the cytopenias, and demonstrated a response to rituximab, which appears to be an effective agent in refractory cases. 56,57 Interestingly, alemtuzumab has also been employed in the treatment of refractory autoimmune cytopenias with responses seen in two-thirds of patients, although a third subsequently relapse. 58,59 The drug also has demonstrated activity in treating MS, but the occurrence of autoimmune thyroid disease and severe delayed ITP has dampened enthusiasm toward its use in MS. As with our 2 patients with MS who developed ITP at 8 and 14 months after transplantation, respectively, the development of ITP among the patients who received alemtuzumab for MS was relatively delayed and manifested up to one year after treatment.…”

Immune anaemias in patients with chronic lymphocytic leukaemia treated with fludarabine, cyclophosphamide and rituximab – incidence and predictors

“…Rituximab has been successfully used in the treatment of immune cytopenias (Shanafelt et al, 2003;Berentsen et al, 2004;Narat et al, 2005;Raj et al, 2005) including warm and cold antibody AIHA and ITP in the setting of CLL and other diseases. Response to rituximab has been reported in patients with fludarabine-related AIHA (Paydas, 2004;Nishida et al, 2006) and PRCA (Ghazal, 2002).…”

Accelerated Allogeneic Haemopoietic Engraftment after Preceding Rituximab-Therapy

“…Rituximab has been used with success for therapy of antibody-mediated thrombocytopenia and haemolysis after allogeneic transplantation and in other situations [30][31][32]. In addition, the successful treatment of chronic GVHD with rituximab as reported by Rathanatarathorn and Cutler suggests interaction of CD20 + cells with cellular immune response [11][12][13].…”