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Faraci M, Dell'Orso G, Giardino S, Pierri F. Autoimmune diseases after allogeneic stem cell transplantation: a clinician's guide and future outlook. Expert Rev Clin Immunol 2022; 18:1-14. [PMID: 35500169 DOI: 10.1080/1744666x.2022.2072299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/27/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Autoimmune disease (AD) may occur after allogeneic hematopoietic stem cell transplantation (HSCT). The autoimmune mechanism seems to be related to an imbalance of the immune regulation effect of T-regulatory lymphocytes on autoreactive T-lymphocytes. AREAS COVERED ADs include hematological ADs (HADs) and nonhematologic ADs (NHADs) involving organs such as thyroid, peripheral and central nervous system, skin, liver, connective tissue, gastrointestinal tract, and kidney. To identify the risk factors for ADs, to report their clinical characteristics, and to discuss new approaches represent the areas covered in this review. EXPERT OPINION Some risk factors for HAD and NHAD are common and include nonmalignant diseases, young age, cord blood as a stem cell source, conditioning regimens without total body irradiation, alemtuzumab, antithymocyte globulin, T-cell-depleted transplant, some viral infection, mixed chimerism, and chronic Graft versus Host Disease. In NHADs, the detection of autoantibodies is more frequent and the transfer of autoimmunity from the donor to the recipient represents the pathogenetic mechanism responsible for these complications. New therapeutic approaches such as bortezomib, daratumumab, sirolimus, eculizumab, and eltrombopag appear to be promising in terms of better efficacy and reduced toxicity compared to traditional therapies. New horizons based on personalized therapies will allow us to improve the prognosis of AD.
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Affiliation(s)
- Maura Faraci
- Hematopoietic Stem Cell Unit, Department of Hematology-Oncology, IRCSS Istituto G. Gaslini I Istituto GGaslini, Genova, Italy
| | - Gianluca Dell'Orso
- Hematopoietic Stem Cell Unit, Department of Hematology-Oncology, IRCSS Istituto G. Gaslini I Istituto GGaslini, Genova, Italy
| | - Stefano Giardino
- Hematopoietic Stem Cell Unit, Department of Hematology-Oncology, IRCSS Istituto G. Gaslini I Istituto GGaslini, Genova, Italy
| | - Filomena Pierri
- Hematopoietic Stem Cell Unit, Department of Hematology-Oncology, IRCSS Istituto G. Gaslini I Istituto GGaslini, Genova, Italy
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Li Z, Rubinstein SM, Thota R, Savani M, Brissot E, Shaw BE, Majhail NS, Mohty M, Savani BN. Immune-Mediated Complications after Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2016; 22:1368-1375. [DOI: 10.1016/j.bbmt.2016.04.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 04/06/2016] [Indexed: 11/27/2022]
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3
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Carpenter PA, Kitko CL, Elad S, Flowers MED, Gea-Banacloche JC, Halter JP, Hoodin F, Johnston L, Lawitschka A, McDonald GB, Opipari AW, Savani BN, Schultz KR, Smith SR, Syrjala KL, Treister N, Vogelsang GB, Williams KM, Pavletic SZ, Martin PJ, Lee SJ, Couriel DR. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: V. The 2014 Ancillary Therapy and Supportive Care Working Group Report. Biol Blood Marrow Transplant 2015; 21:1167-87. [PMID: 25838185 DOI: 10.1016/j.bbmt.2015.03.024] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 03/27/2015] [Indexed: 12/26/2022]
Abstract
The 2006 National Institutes of Health (NIH) Consensus paper presented recommendations by the Ancillary Therapy and Supportive Care Working Group to support clinical research trials in chronic graft-versus-host disease (GVHD). Topics covered in that inaugural effort included the prevention and management of infections and common complications of chronic GVHD, as well as recommendations for patient education and appropriate follow-up. Given the new literature that has emerged during the past 8 years, we made further organ-specific refinements to these guidelines. Minimum frequencies are suggested for monitoring key parameters relevant to chronic GVHD during systemic immunosuppressive therapy and, thereafter, referral to existing late effects consensus guidelines is advised. Using the framework of the prior consensus, the 2014 NIH recommendations are organized by organ or other relevant systems and graded according to the strength and quality of supporting evidence.
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Affiliation(s)
- Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Carrie L Kitko
- Blood and Marrow Transplantation Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Sharon Elad
- Division of Oral Medicine, Eastman Institute for Oral Health and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York
| | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Juan C Gea-Banacloche
- Center for Cancer Research National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jörg P Halter
- Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Flora Hoodin
- Department of Psychology, Eastern Michigan University, Ypsilanti, Michigan
| | - Laura Johnston
- Department of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, California
| | - Anita Lawitschka
- St. Anna Children's Hospital, Medical University, Vienna, Austria
| | - George B McDonald
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Anthony W Opipari
- Department of Obstetrics and Gynecology, University of Michigan Health System, Ann Arbor, Michigan
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kirk R Schultz
- Michael Cuccione Childhood Cancer Research Program, BC Children's Hospital and University of BC, Vancouver, British Columbia
| | - Sean R Smith
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan
| | - Karen L Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Nathaniel Treister
- Division of Oral Medicine and Dentistry, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Georgia B Vogelsang
- Oncology Department, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kirsten M Williams
- Center for Cancer Research National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Steven Z Pavletic
- Center for Cancer Research National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Paul J Martin
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Daniel R Couriel
- Blood and Marrow Transplantation Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
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4
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Holbro A, Abinun M, Daikeler T. Management of autoimmune diseases after haematopoietic stem cell transplantation. Br J Haematol 2012; 157:281-90. [PMID: 22360687 DOI: 10.1111/j.1365-2141.2012.09070.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 01/27/2012] [Indexed: 12/29/2022]
Abstract
Autologous and allogeneic haematopoietic stem cell transplantation (HSCT) is an option for the treatment of malignant and non-malignant diseases, including the severe autoimmune diseases. Intriguingly, the 'new' autoimmunity developing after transplantation is a constantly recognized phenomenon, which has to be differentiated from original disease relapse, toxicity, infection and graft-versus-host disease. The reported autoimmune diseases occurring in this setting are mainly antibody-associated and organ-specific, with scarce evidence in support for specific treatment options. This review focuses on current concepts on the pathogenesis, the available data on incidence, risk factors, manifestations and treatment of post-HSCT autoimmune diseases.
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Affiliation(s)
- Andreas Holbro
- Clinic of Haematology, University Hospital, Basel, Switzerland
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5
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Rovelli A, D'angelo P, Balduzzi A, Borzini P, Biondi A, Uderzo C. Acute Intravascular Haemolysis Associated with High Dose Immunoglobulin after Bone Marrow Transplantation for Acute Myelogenous Leukemia. Leuk Lymphoma 2009; 5:71-4. [DOI: 10.3109/10428199109068107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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6
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Nomura S, Ishii K, Inami N, Matsuzaki T, Yamaoka M, Urase F, Maeda Y, Fukuhara S. Antiglycoprotein IIb-IIIa autoantibody in a patient with immune thrombocytopenia after cord blood transplantation. Clin Appl Thromb Hemost 2009; 15:123-4. [PMID: 19150997 DOI: 10.1177/1076029607305781] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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7
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Transfer of donor immune thrombocytopenic purpura to a recipient of an allogeneic haematopoietic stem cell graft. Bone Marrow Transplant 2009; 44:203-4. [DOI: 10.1038/bmt.2009.3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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8
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Li XM, Hu Z, Sola-Visner M, Hensel S, Garner R, Zafar AB, Wingard JR, Jorgensen ML, Fisher RC, Scott EW, Slayton WB. Sites and kinetics of donor thrombopoiesis following transplantation of whole bone marrow and progenitor subsets. Exp Hematol 2007; 35:1567-79. [PMID: 17697746 DOI: 10.1016/j.exphem.2007.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Revised: 06/12/2007] [Accepted: 06/14/2007] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Little is known about the sites and kinetics of thrombopoiesis following bone marrow transplant. The spleen is a site of hematopoiesis in a healthy mouse, and hematopoietic activity increases in response to stress. We hypothesized that the spleen is a major site of early post-transplant thrombopoiesis. METHODS We transplanted whole bone marrow (WBM) or lineage depleted progenitor subsets fractionated based on expression of c-kit and Sca-1 from transgenic mice expressing green fluorescent protein into lethally irradiated C57BL/6 recipients. We also transplanted whole bone marrow cells into healthy and splenectomized mice. Post-transplant megakaryopoiesis was assessed by measuring circulating platelet number, percent donor-derived platelets, bone marrow cellularity, splenic weight, megakaryocyte size, and megakaryocyte concentration from hour 3 to day 28 post transplant. RESULTS Following transplant, circulating donor-derived platelets were derived only from c-kit expressing subsets. Donor-derived platelets first appeared on post-transplant day five. Splenectomy reduced the number of these earliest circulating platelets. Splenic megakaryopoiesis increased dramatically from day 7-14 post-transplant. However, splenectomy accelerated platelet engraftment during this time frame. CONCLUSION Overall, these results demonstrate that the first platelets are produced by c-kit expressing megakaryocyte progenitors in the bone marrow and spleen. After post-transplant day 5, the net effect of the spleen on thrombopoiesis is to slow engraftment due to immune effects or hypersplenism.
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Affiliation(s)
- Xiao-Miao Li
- Department of Pediatrics, University of Florida, Gainesville, USA
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9
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Couriel D, Carpenter PA, Cutler C, Bolaños-Meade J, Treister NS, Gea-Banacloche J, Shaughnessy P, Hymes S, Kim S, Wayne AS, Chien JW, Neumann J, Mitchell S, Syrjala K, Moravec CK, Abramovitz L, Liebermann J, Berger A, Gerber L, Schubert M, Filipovich AH, Weisdorf D, Schubert MM, Shulman H, Schultz K, Mittelman B, Pavletic S, Vogelsang GB, Martin PJ, Lee SJ, Flowers MED. Ancillary therapy and supportive care of chronic graft-versus-host disease: national institutes of health consensus development project on criteria for clinical trials in chronic Graft-versus-host disease: V. Ancillary Therapy and Supportive Care Working Group Report. Biol Blood Marrow Transplant 2006; 12:375-96. [PMID: 16545722 DOI: 10.1016/j.bbmt.2006.02.003] [Citation(s) in RCA: 270] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2006] [Accepted: 02/07/2006] [Indexed: 12/23/2022]
Abstract
The Ancillary Therapy and Supportive Care Working Group had 3 goals: (1) to establish guidelines for ancillary therapy and supportive care in chronic graft-versus-host disease (GVHD), including treatment for symptoms and recommendations for patient education, preventive measures, and appropriate follow-up; (2) to provide guidelines for the prevention and management of infections and other common complications of treatment for chronic GVHD; and (3) to highlight the areas with the greatest need for clinical research. The definition of "ancillary therapy and supportive care" embraces the most frequent immunosuppressive or anti-inflammatory interventions used with topical intent and any other interventions directed at organ-specific control of symptoms or complications resulting from GVHD and its therapy. Also included in the definition are educational, preventive, and psychosocial interventions with this same objective. Recommendations are organized according to the strength and quality of evidence supporting them and cover the most commonly involved organs, including the skin, mouth, female genital tract, eyes, gastrointestinal tract, and lungs. Recommendations are provided for prevention of infections, osteoporosis, and steroid myopathy and management of neurocognitive and psychosocial adverse effects related to chronic GVHD. Optimal care of patients with chronic GVHD often requires a multidisciplinary approach.
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Affiliation(s)
- Daniel Couriel
- University of Texas MD Anderson Cancer Center, Houston, 77030, USA.
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Yamazaki R, Kuwana M, Mori T, Okazaki Y, Kawakami Y, Ikeda Y, Okamoto S. Prolonged thrombocytopenia after allogeneic hematopoietic stem cell transplantation: associations with impaired platelet production and increased platelet turnover. Bone Marrow Transplant 2006; 38:377-84. [PMID: 16915226 DOI: 10.1038/sj.bmt.1705444] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To evaluate the mechanisms underlying prolonged thrombocytopenia after allogeneic hematopoietic stem cell transplantation (SCT), an index for plasma glycocalicin normalized for the individual platelet count (GCI), plasma thrombopoietin (TPO), and circulating B cells producing anti-GPIIb-IIIa antibodies were measured in 50 SCT recipients with or without prolonged thrombocytopenia, 42 patients with idiopathic thrombocytopenic purpura, nine patients with aplastic anemia, and 22 healthy individuals. All three indices were significantly higher in the SCT recipients with thrombocytopenia than in those without (P < 0.01 for all comparisons), and were significantly correlated with the platelet count in SCT recipients. Stepwise multiple regression analysis of the samples from the SCT recipients revealed that GCI and TPO independently pointed to specific mechanisms of thrombocytopenia. The GCI and TPO status in SCT recipients with thrombocytopenia had a pattern similar to that seen in aplastic anemia, suggesting a major role for impaired thrombopoiesis. An antiplatelet antibody response was frequently detected in SCT recipients, but the development of thrombocytopenia is likely to depend on additional factors, such as reticuloendothelial function. In summary, post transplant prolonged thrombocytopenia is associated with complex mechanisms, including impaired thrombopoiesis and increased platelet turnover.
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Affiliation(s)
- R Yamazaki
- Division of Hematology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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11
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Vinzio S, Lioure B, Grunenberger F, Schlienger JL, Goichot B. [Auto-immune-like disease post-bone marrow transplantation]. Rev Med Interne 2004; 25:514-23. [PMID: 15219370 DOI: 10.1016/j.revmed.2003.12.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2003] [Accepted: 12/21/2003] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Bone marrow transplantation (BMT) is based on destruction of the patient's bone marrow with rescue of haematopoietic stem cells from a donor. Chronic graft-vs-host disease (GVH) is the major complication post-BMT and mimics some autoimmune diseases, such as scleroderma, sicca syndrome, primary biliary cirrhosis and an increased prevalence of various autoantibodies. Other autoimmune-like manifestations have been reported as case reports or short series. The most common are myasthenia gravis, polymyositis, autoimmune cytopenias and Graves' disease or autoimmune hypothyroidism. CURRENT KNOWLEDGE AND KEY POINTS These diseases occur mainly in association with chronic GVH. The pathophysiology of chronic GVH and other autoimmune-like diseases post-BMT remains poorly understood. Different mechanisms have been postulated. Most of the autoimmune events (either chronic GVH or more specific diseases) seem to be related to a poor or inadequate immunologic recovery post-BMT with an imbalance between autoregulatory and autoreactive lymphocytes. Microchimerism and molecular mimicry have been recently evocated. A minority of cases (autoimmune thyroid disorders) is attributed to the direct transfer of autoreactive cells from donor to patient (adoptive immunity). FUTURE PERSPECTIVES Despite physiopathologic uncertainty, these autoimmune-like disorders post-BMT are an interesting model for primary autoimmune diseases.
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Affiliation(s)
- S Vinzio
- Service de médecine interne et nutrition, hôpital de Hautepierre, avenue Molière, 67098 Strasbourg cedex, France.
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12
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Demirer T, Ilhan O, Arat M, Genç Y, Ozcan M, Dalva K, Celebi H, Beksaç M, Akan H, Gürman G, Konuk N, Uysal A, Arslan O, Koç H. CD41+ and CD42+ hematopoietic progenitor cells may predict platelet engraftment after allogeneic peripheral blood stem cell transplantation. J Clin Apher 2002; 16:67-73. [PMID: 11746531 DOI: 10.1002/jca.1015] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The objective of this study was to quantify subpopulations of CD34+ cells such as CD41+ and CD42+ cells that might represent megakaryocyte (MK) precursors in peripheral blood stem cell (PBSC) collections of normal, recombinant human granulocyte-colony stimulating factor (rhG-CSF) primed donors and to determine whether there is a statistical association between the dose infused megakaryocytic precursors and the time course of the platelet recovery following an allogeneic PBSC transplantation. Twenty-six patients with various hematologic malignancies transplanted from their HLA identical siblings between July 1997 and December 1999 were used. All patients except one with severe aplastic anemia who had cyclophosphamide (CY) alone received busulfan-CY as preparative regimen and cyclosporine-methotrexate for GVHD prophylaxis. Normal healthy donors were given rhG-CSF 10 microg/kg/day subcutaneously twice daily and PBSCs were collected on days 5 and 6. The median number of infused CD34+, CD41+ and CD42+ cells were 6.61 x 10(6)/kg (range 1.47-21.41), 54.85 x 10(4)/kg (5.38-204.19), and 49.86 x 10(4)/kg (6.82-430.10), respectively. Median days of ANC 0.5 x 10(9)/L and platelet 20 x 10(9)/L were 11.5 (range 9-15) and 13 (8-33), respectively. In this study, the number of CD41+ and CD42+ cells infused much better correlated than the number of CD34+ cells infused with the time to platelet recovery of 20 x 10(9)/L in 26 patients receiving an allogeneic match sibling PBSC transplantation (r = -0.727 and P < 0.001 for CD41+ cells, r = -0.806 and P < 0.001 for CD42+ cells, r = -0.336 and P > 0.05 for CD34+ cells). There was an inverse correlation between the number of infused CD41+ and CD42+ cells and duration of platelet engraftment. Therefore, as the number of CD41+ and CD42+ cells increased, duration of platelet engraftment (time to reach platelet count of > or = 20 x 10(9)/L) shortened significantly. Based on this data we may conclude that flow cytometric measurement of CD41+ and CD42+ progenitor cells may provide an accurate indication of platelet reconstitutive capacity of the allogeneic PBSC transplant.
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Affiliation(s)
- T Demirer
- Department of Hematology and Bone Marrow Transplantation Unit, Ankara University Medical School, Ibn-i Sina Hospital, Sihhiye, Ankara, Turkey.
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13
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Pratt G, Kinsey SE. Remission of severe, intractable autoimmune haemolytic anaemia following matched unrelated donor transplantation. Bone Marrow Transplant 2001; 28:791-3. [PMID: 11781633 DOI: 10.1038/sj.bmt.1703232] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2001] [Accepted: 07/30/2001] [Indexed: 11/09/2022]
Abstract
Immune-mediated haemolytic anaemia presenting post allogeneic bone marrow transplantation is often alloimmune in origin due to ABO or minor red cell incompatibilities. Autoimmune haemolytic anaemia is also recognised, is frequently difficult to treat and overall prognosis is often poor, usually from associated problems. Here, we present a case report of autoimmune haemolysis presenting in an 8-year-old boy 6 months post allogeneic bone marrow transplant requiring 4 years of immunosuppressive therapy before remission of haemolysis. This case report highlights the fact that it is possible for haemolysis to resolve post transplant even after years of immunosuppressive therapy.
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MESH Headings
- Adrenal Cortex Hormones/therapeutic use
- Alemtuzumab
- Anemia, Hemolytic, Autoimmune/drug therapy
- Anemia, Hemolytic, Autoimmune/etiology
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal, Humanized
- Antibodies, Neoplasm
- Blood Transfusion
- Bone Marrow Transplantation/adverse effects
- Child
- Combined Modality Therapy
- Cranial Irradiation
- Cyclophosphamide
- Cyclosporine/administration & dosage
- Graft vs Host Disease/prevention & control
- Humans
- Immunoglobulins, Intravenous/therapeutic use
- Immunosuppressive Agents/therapeutic use
- Leukemia-Lymphoma, Adult T-Cell/complications
- Leukemia-Lymphoma, Adult T-Cell/drug therapy
- Leukemia-Lymphoma, Adult T-Cell/radiotherapy
- Leukemia-Lymphoma, Adult T-Cell/therapy
- Lymphocyte Depletion
- Male
- Prednisolone/administration & dosage
- Remission Induction
- Thalidomide/therapeutic use
- Transplantation Conditioning/adverse effects
- Transplantation, Homologous/adverse effects
- Whole-Body Irradiation
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Affiliation(s)
- G Pratt
- Yorkshire Regional Centre for Paediatric Oncology and Haematology, St James's University Hospital, Leeds, UK
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14
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Tomonari A, Tojo A, Lseki T, Ooi J, Nagayama H, Ogami K, Maekawa T, Shirafuji N, Tani K, Asano S. Severe autoimmune thrombocytopenia after allogeneic bone marrow transplantation for aplastic anemia. Int J Hematol 2001; 74:228-32. [PMID: 11594527 DOI: 10.1007/bf02982010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Autoimmune thrombocytopenia (AITP) after bone marrow transplantation (BMT) was suggested to occur by immune dysregulation mainly in association with graft-versus-host disease (GVHD). Here we present a patient who developed severe AITP after BMT. A 40-year-old woman with severe aplastic anemia received a BMT from a partially HLA-matched brother. Despite myeloid and erythroid engraftments, platelet recovery was delayed. All bone marrow cells were 46,XY and were derived from the donor. Grade I acute GVHD involving skin developed from day 34 posttransplantation, but promptly responded to prednisolone in addition to a prophylactic dose of tacrolimus. With the tapering of prednisolone, thrombocytopenia progressed without substantial changes in the white blood cell count, hemoglobin concentration, or reticulocyte count. On day 188, the patient developed chronic GVHD involving skin and liver, which promptly responded to the readministration of prednisolone and increased tacrolimus. However, the patient's platelet count decreased to 9 x 10(9) cells/L on day 222. The platelet-associated immunoglobulin G (PAIgG) values were elevated. Bone marrow examination showed hypercellularity with plentiful megakaryocytes. The number of colony-forming units-megakaryocyte was within the normal range. The elevated PAIgG values and a correlation between thrombocytopenia and the intensity of the immunosuppressive agents strongly suggested a causative role of the autoimmune mechanisms for thrombocytopenia in this patient.
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Affiliation(s)
- A Tomonari
- Department of Hematology/Oncology, Institute of Medical Science, The University of Tokyo, Japan.
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15
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Bojko P, Hester JP, Durett AG, Maadani F, Körbling M, Champlin RE. Identification of megakaryocyte precursors in peripheral blood stem cell collections from normal donors. J Clin Apher 2000; 13:7-15. [PMID: 9590491 DOI: 10.1002/(sici)1098-1101(1998)13:1<7::aid-jca2>3.0.co;2-d] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Platelet engraftment, the time course and magnitude of platelet recovery (PR) post-transplant, is imprecisely defined but is most often reported as the time to transfusion (tx) independence and/or a platelet count > or = 20,000/microl. While correlations between engraftment time for granulocytes (PMN) and the dose of CD34-positive cells per kilogram are established, such associations have not been established for platelet engraftment. The objective of this study was to quantify subpopulations of CD34-positive cells in peripheral blood stem cell (PBSC) collections of normal, colony-stimulating factor-granulocyte) (G-CSF) primed donors that might represent megakaryocyte (MK) precursors, and to determine whether there is a statistical association between the dose transfused and the time course of the recovery. Based on previously published data of the sequential expression of CD34, HLA-DR, and CD61, among others, during MK maturation, a combination of corresponding antibodies for the detection of various antigen coexpressions by flow cytometry fluorescence-activated cell sorting [FACS] was chosen. CD34-positive cells were further subdivided into CD34++ (bright) and + (dim). Ploidy of density-gradient separated cells was examined in subsequent donor samples by FACS. For the entire group of patients, there was no strong correlation between any of the studied subpopulations and time to PR. Only in a selected groups of patients whose platelet counts showed a sustained increase during the first 6 days after engraftment, there was a weak correlation between the time to PR and the quantity of CD34+/+CD61+ (r = -0.57) and CD34++HLA-DR-CD61+ (r = -0.62) cells infused. The magnitude of platelet production in these pt., a product of the peripheral blood platelet count and the patient's blood volume, was correlated with the time to PR (r = -0.73). We conclude from this study that subpopulations within CD34+ cells are making some contribution to PR in allogeneic peripheral blood stem cell transplantation, but the correlations are not sufficiently strong because there are probably too many unpredictable and unknown variables in the allogeneic setting that influence the pattern of engraftment.
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Affiliation(s)
- P Bojko
- University of Texas, M.D. Anderson Cancer Center, Section of Blood and Marrow Transplantation, Houston, USA
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16
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Delaflor-Weiss E, Mintz PD. The evaluation and management of platelet refractoriness and alloimmunization. Transfus Med Rev 2000; 14:180-96. [PMID: 10782501 DOI: 10.1016/s0887-7963(00)80007-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- E Delaflor-Weiss
- Department of Pathology, University of Virginia Health System, Charlottesville 22908, USA
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Novotný VM, Doxiadis II, Brand A. The reduction of HLA class I expression on platelets: a potential approach in the management of HLA-alloimmunized refractory patients. Transfus Med Rev 1999; 13:95-105. [PMID: 10218233 DOI: 10.1016/s0887-7963(99)80004-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- V M Novotný
- Blood Bank Leidsenhage, Leiden, The Netherlands
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18
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Nevo S, Enger C, Swan V, Wojno KJ, Fuller AK, Altomonte V, Braine HG, Noga SJ, Vogelsang GB. Acute bleeding after allogeneic bone marrow transplantation: association with graft versus host disease and effect on survival. Transplantation 1999; 67:681-9. [PMID: 10096522 DOI: 10.1097/00007890-199903150-00007] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Hemorrhagic complications are frequently implicated clinically for the high morbidity and mortality of acute graft versus host disease (GVHD), however, only few reports characterize the incidence and timing of bleeding in relation to GVHD, and essentially no study has quantified the effect of bleeding on survival of allogeneic patients with GVHD. This study examines the association of bleeding with acute GVHD and the effect of both complications on survival. METHODS A total of 463 allogeneic patients transplanted at the Johns Hopkins Hospital, were included in the study. Bleeding evaluation was based on daily scores of intensity and blood transfusions. All bleeding sites were recorded. GVHD staging was defined by the extent of rash, serum bilirubin, diarrhea, and confirmatory histology. RESULTS The incidence of GVHD was 27.4%, bleeding occurred in 40.2%. The incidence of bleeding was higher in patients with GVHD as compared with non-GVHD, and correlated with GVHD severity. The higher bleeding incidence in GVHD was due to gastrointestinal hemorrhage, hemorrhagic cystitis, and pulmonary hemorrhage. While the majority of bleeding (51/75) in non-GVHD patients initiated within 30 days after bone marrow transplantation (BMT), only 32.3% (21/65) of the bleeding in the GVHD group initiated within 30 days, and the risk for bleeding continued until day 100. Bleeding was a late event compared to GVHD, however, most bleeding episodes were associated with active GVHD. Both GVHD and bleeding were individually associated with reduced survival, with profound additive adverse effect: median survival in 221 nonbleeding non-GVHD was >83.2 months, GVHD nonbleeding (39 patients) had median of 10.6 months, bleeding non-GVHD (99 patients) had median of 4.3 months, and median survival of the GVHD bleeding group (85 patients) was 3.2 months. CONCLUSIONS Our results support an association of bleeding with acute GVHD, suggesting that GVHD is a risk factor for bleeding after BMT. The occurrence of bleeding clearly identified poor outcome subgroup within GVHD, suggesting further evaluation for clinical application of bleeding in the assessment of GVHD severity.
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Affiliation(s)
- S Nevo
- Johns Hopkins Oncology Center, Baltimore, Maryland 21287-8985, USA
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19
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20
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McCullough J. Collection and use of stem cells; role of transfusion centers in bone marrow transplantation. Vox Sang 1994; 67 Suppl 3:35-42. [PMID: 7975510 DOI: 10.1111/j.1423-0410.1994.tb04541.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Marrow transplantation is increasing, hematopoietic stem cells are being obtained from a wider variety of donors, and the cells almost always undergo some processing steps. These activities, along with the hematologic complexities of marrow transplant patients, create many varied opportunities for blood centers.
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Affiliation(s)
- J McCullough
- Department of Laboratory Medicine & Pathology, University of Minnesota Hospital, Minneapolis
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21
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Marmont AM. Immune ablation followed by allogeneic or autologous bone marrow transplantation: a new treatment for severe autoimmune diseases? Stem Cells 1994; 12:125-35. [PMID: 8142916 DOI: 10.1002/stem.5530120119] [Citation(s) in RCA: 82] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- A M Marmont
- Division of Hematology II, S. Martino's Hospital, Genoa, Italy
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22
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Klumpp T. Autoimmune pancytopenia following bone marrow transplantation. Br J Haematol 1992; 80:135-6. [PMID: 1536805 DOI: 10.1111/j.1365-2141.1992.tb06419.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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23
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24
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Benda H, Panzer S, Kiefel V, Mannhalter C, Hinterberger W, Lechner K, Mueller-Eckhardt C. Identification of the target platelet glycoprotein in autoimmune thrombocytopenia occurring after allogeneic bone marrow transplantation. BLUT 1989; 58:151-3. [PMID: 2649188 DOI: 10.1007/bf00320436] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We report the case of a patient who developed autoimmune thrombocytopenia after allogeneic bone marrow transplantation from her HLA-identical sister. An IgG autoantibody was detected that bound to the platelet glycoprotein IIb/IIIa and to the HLA class I proteins. Immunoprecipitation studies with radiolabeled platelets revealed additional antibody binding sites on proteins of 214 kDa molecular weight under nonreduced conditions and 65 and 56 kDa molecular weight under reduced conditions.
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Affiliation(s)
- H Benda
- Division of Hematology and Blood Coagulation, University of Vienna, Austria
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25
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Panzer S, Kiefel V, Bartram CR, Haas OA, Hinterberger W, Mueller-Eckhardt C, Lechner K. Immune thrombocytopenia more than a year after allogeneic marrow transplantation due to antibodies against donor platelets with anti-PlA1 specificity: evidence for a host-derived immune reaction. Br J Haematol 1989; 71:259-64. [PMID: 2647127 DOI: 10.1111/j.1365-2141.1989.tb04264.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We report on a male patient transplanted from his HLA-matched sister for Ph1-chromosome positive chronic myelogenous leukaemia who developed immune thrombocytopenia more than 1 year after transplantation. The platelet antibody reacted with the platelet specific antigen PlA1 on donor platelets, and also on recipient platelets after engraftment. A presumed host-versus-donor induced thrombocytopenia was supported by Southern blot analysis using a Y-chromosome specific probe demonstrating residual host-origin cells in the patient's excised spleen.
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Affiliation(s)
- S Panzer
- First Medical Clinic, University of Vienna, Austria
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