Successful treatment of pure red cell aplasia after major ABO-incompatible T cell-depleted bone marrow transplantation with erythropoietin

Summary:Transplantation between red cell-disparate donor and recipient is feasible with minimal increase in the risk of transplantation if consideration is given to the immunohematological consequences of the transplant. The risks of immediate and delayed hemolysis must be managed. Some recipients will experience a delay in the recovery of red blood cells. Bone Marrow Transplantation (2001) 28, 315-321.

Section: Major Red Cell Incompatibilitymentioning

confidence: 99%

Hematopoietic stem cell transplantation between red cell incompatible donor–recipient pairs

Rowley

2001

“…Major ABO-incompatible HSCT recipients may experience delayed red cell recovery after transplantation because of persistent host isohemagglutinins that suppress donor's red cell hematopoiesis. 6 Several methods have been used for treatment of this complication: removal of ABO antibodies by large-volume plasmapheresis prior or after transplantation, 7 transfusion of donor-type red cells, 8 removal of anti-A and anti-B antibodies by immunoadsorption on immobilized blood group antigens, 9 erythropoietin (EPO) to enhance red cell production, 10 immunosuppression with glucocorticoids or antithymocyte globulin and treatment with rituximab. 11 Removal of immunoglobulins with Ig-Therasorb s immunoadsorption is a novel method for the treatment of various hematologic and immunologic diseases, such as acquired coagulation factor inhibitors, dilated cardiomyopathy and the removal of anti-HLA antibodies prior to renal transplantation.…”

mentioning

confidence: 99%

Prolonged red cell aplasia after major ABO-incompatible allogeneic hematopoietic stem cell transplantation: removal of persisting isohemagglutinins with Ig-Therasorb® immunoadsorption

Rabitsch

Knöbl

Prinz

et al. 2003

Summary:Delayed donor red cell engraftment and prolonged red cell aplasia (PRCA) are well-recognized complications of major ABO-incompatible myeloablative and nonmyeloablative hematopoietic stem cell transplantation (HSCT). There is an intense debate about the impact on outcome, severity of hemolysis, association with graft-versus-host disease and survival after blood group-incompatible stem cell transplantation. Therefore, therapeutic strategies should be considered to avoid these possible complications. We present five patients, who received allogeneic HSCT from human leukocyte antigen-identical donors for hematological malignancies, which were treated with IgTherasorb s immunoadsorption (five treatments/week) to remove persisting incompatible isohemagglutinins. After a median of 17 treatments (range 9-25), all the patients became transfusion independent with the presentation of donor's blood group. No side effects occurred during treatment. Ig-Therasorb s immunoadsorption seems to be a promising therapeutic method for rapid, efficient and safe elimination for persisting isohemagglutinins for patients with PRCA after allogeneic hematological stem cell transplantation.

“…2 In our patient, in vitro studies revealed that the patient's fresh serum inhibited normal marrow erythroid colony formation, suggesting a complement-dependent inhibition of erythroid progenitor cells. In addition, cytogenetic data documented a progressive graft failure.…”

Section: Discussionmentioning

confidence: 99%

“…4 A wellrecognized mechanism of PRCA complicating major ABOincompatible BMT involves antibodies towards red cell precursors; 2 a T cell-mediated suppression of erythropoiesis has also been described. 2 ABO-incompatible BMT is a difficult task; various immunosuppressive regimens, erythropoietin and plasmapheresis have been used with variable results. 2 Immunemediated mechanisms may also play a key role in the development of late graft failure.…”

mentioning

confidence: 99%

“…2 ABO-incompatible BMT is a difficult task; various immunosuppressive regimens, erythropoietin and plasmapheresis have been used with variable results. 2 Immunemediated mechanisms may also play a key role in the development of late graft failure. 5 Graft rescue by infusing peripheral blood stem cells (PBSC) may be an effective therapy for patients with early or late graft failure, 6 whereas donor lymphocyte infusions (DLI) have been primarily used for treating or preventing cytogenetic or early hematological CML relapse.…”

mentioning

confidence: 99%

See 1 more Smart Citation

CD34+-enriched donor lymphocyte infusions in a case of pure red cell aplasia and late graft failure after major ABO-incompatible bone marrow transplantation

Selleri

Raiola

Rosa

et al. 1998

Summary:A variety of immunohematological complications may occur after ABO-incompatible BMT. We report a CML patient (blood group O) who received a BMT from an HLA-identical sibling (blood group AB). The transplant was followed by normal myeloid and megakaryocytic engraftment, but erythroblastopenia persisted for more than 200 days after BMT. By bone marrow culture studies, a complement-dependent serum inhibitor of hemopoiesis was detected, suggesting immunological inhibition of erythropoiesis. The patient was resistant to a number of treatments such as intravenous gammaglobulins, prednisolone and high-dose erythropoietin. Full engraftment with normal blood counts and marrow cellularity was achieved after two dose-escalating CD34 + -enriched donor lymphocyte infusions (DLI). This experience suggests that CD34 + -enriched DLI may be an effective treatment for patients with delayed engraftment or late graft failure due to major ABOincompatibility. Keywords: PRCA; graft failure; DLI; CD34 + cells Allogeneic bone marrow transplant with major ABO incompatibility may be associated with delayed erythroid engraftment that may either regress spontaneously or become chronic. Acquired pure red cell aplasia (PRCA) has been reported after major ABO-incompatible transplant from peripheral blood 1 or marrow, 2 unmanipulated or T cell-depleted progenitor cells. It is characterized by severe anemia, reticulocytopenia and absence of erythroblasts in otherwise normally engrafted bone marrow. Although human parvovirus B19 may be a causative agent of PRCA following BMT, 3 more frequently autoimmune or alloimmune mechanisms have a role in its pathogenesis. 4 A wellrecognized mechanism of PRCA complicating major ABOincompatible BMT involves antibodies towards red cell precursors; 2 a T cell-mediated suppression of erythropoiesis has also been described. ABO-incompatible BMT is a difficult task; various immunosuppressive regimens, erythropoietin and plasmapheresis have been used with variable results. 2 Immunemediated mechanisms may also play a key role in the development of late graft failure. 5 Graft rescue by infusing peripheral blood stem cells (PBSC) may be an effective therapy for patients with early or late graft failure, 6 whereas donor lymphocyte infusions (DLI) have been primarily used for treating or preventing cytogenetic or early hematological CML relapse. 7 We report a case of PRCA followed by a progressive graft failure complicating an ABO-incompatible allogeneic BMT for CML in chronic phase, that was successfully treated with CD34 + -enriched DLI. Case reportA 20-year-old woman underwent BMT from her HLAidentical brother 6 months after the diagnosis of CML in chronic phase. We used the conditioning regimen BU/CY2; GVHD prophylaxis was carried out with CYA (2 mg/kg) and short-course methotrexate. As the donor's blood group was AB (Rh: CcDee; Kell positive) and the recipient's was O (Rh: CCDee; Kell negative), erythrocyte-depleted marrow containing 3.8 × 10 6 /kg CD34 + cells and 2.54 × 10 4 /kg CFU-GM was transplanted. E...