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Deng B, Gao R, Yang B, Lei WB, Xue MF, Wang JS, Zhao P. Seven-years post allogeneic hematopoietic stem cell transplantation pure red cell aplastic anemia cured with daratumumab: A case report and review of literature. World J Clin Cases 2024; 12:5604-5612. [PMID: 39188601 PMCID: PMC11269989 DOI: 10.12998/wjcc.v12.i24.5604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/04/2024] [Accepted: 06/26/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Allogeneic hematopoietic stem cell transplantation (Allo-HSCT) is currently the only viable method of curing patients with acute myeloid leukaemia. In 30% to 50% of patients, donors and recipients have some level of ABO blood group incompatibility. ABO blood group incompatibility can cause antibodies against the donor's red blood cells to persist in the recipient's body, resulting in a delay of several months in the recovery of red blood cells. A number of different treatments have been reported for post-transplant pure red cell aplastic anaemia (PRCA), such as plasmapheresis, donor lymphocyte infusions, anti-thymocyte globulin, rituximab and steroids. CASE SUMMARY A 41-year-old female diagnosed with acute myeloid leukaemia underwent peripheral blood allogeneic haematopoietic stem cell transplantation in November 2013 from an HLA matched unrelated donor. The donor was AB-positive and the recipient was O-positive. The patient was diagnosed with PRCA three months after receiving the donor stem cell transplant. After failing multiple lines of therapy, the patient applied for daratumumab. After receiving three doses of daratumumab, the patient developed a reticulocyte response and no longer required blood transfusions. CONCLUSION The use of daratumumab anti-CD38 for the remove of plasma cells is safe and effective and may be tried for refractory patients with PRCA after undergoing allo-HSCT for ABO incompatibility.
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Affiliation(s)
- Bo Deng
- Department of Haematology, Guizhou Hospital, The First Affiliated Hospital of Sun Yat-sen University, Guiyang 550001, Guizhou Province, China
| | - Rui Gao
- Department of Hematology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550001, Guizhou Province, China
| | - Bing Yang
- School of Clinical Medicine, Guizhou Medical University, Guiyang 550001, Guizhou Province, China
| | - Wen-Bing Lei
- School of Clinical Medicine, Guizhou Medical University, Guiyang 550001, Guizhou Province, China
| | - Ming-Fang Xue
- School of Clinical Medicine, Guizhou Medical University, Guiyang 550001, Guizhou Province, China
| | - Ji-Shi Wang
- Department of Hematology, The Affiliated Hospital of Guizhou Medical University, Hematological Institute of Guizhou Province, Guiyang 550001, Guizhou Province, China
| | - Peng Zhao
- Department of Hematology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550001, Guizhou Province, China
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Metafuni E, Busnego Barreto MT, Valentini CG, Giammarco S, Limongiello MA, Sorà F, Bianchi M, Massini G, Piccirillo N, Putzulu R, Frioni F, Bacigalupo A, Teofili L, Chiusolo P, Sica S. Pure red cell aplasia among ABO mismatched hematopoietic stem cell transplant recipients: a 13-years retrospective study and literature review. Front Oncol 2024; 14:1386670. [PMID: 39015495 PMCID: PMC11250070 DOI: 10.3389/fonc.2024.1386670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/10/2024] [Indexed: 07/18/2024] Open
Abstract
Background Pure red cell aplasia (PRCA) is a possible complication after allogeneic hematopoietic stem cell transplantation (HSCT) with major ABO incompatibility. Patients experience delayed engraftment of the erythroid series, with prolonged transfusion-dependent anemia and iron overload. Methods We performed a revision of the most recent literature about post-HSCT PRCA treatment procedures. Moreover, we conducted a retrospective study, over the last 13-years, which included all consecutive major ABO mismatched HSCT performed in our unit, with the aim to assess PRCA incidence, risk factors, and response to different treatments. Overall, 194 patients received a major ABO mismatched transplant from 2010 to 2022. For each patient, data about demographic and transplant characteristics, engraftment, blood transfusion, and possible treatment received were collected. Results The literature review returned 23 eligible papers on PRCA treatment, with high success rate using plasma-exchange (PEX) and immunoadsorption procedures, daratumumab, and eltrombopag. Our study identified a total of 24 cases of PRCA. Among risk factors for PRCA development, we have found older recipient age (p=0.01), high pre-HSCT IgG and IgM IHA titer (p<0.0001), major rather than bidirectional ABO incompatibility (p=0.02), low T CD8 lymphocyte count in the graft (p=0.006), relative donor (p=0.02) and bone marrow as stem cell source (p=0.002). However, multivariate analysis confirmed only pre-HSCT IgG IHA titer as the unique risk factor for PRCA occurrence. The optimal cut-off value of pre-HSCT IgG IHA for PRCA development, resulted to be 1/64, with a 100% sensitivity and 68.8% specificity (p<0.0001). All patients with PRCA had received rhEPO and transfusion support and 20 patients received additional treatments like PEX, rituximab, and more recently daratumumab. Comprehensively, PEX and rituximab obtained a response in half of the cases, at a variable time, while the few cases of patients we treated with daratumumab suggest promising results. The overall response rate in our cohort was 75%, with significantly better survival (94.4% vs. 16.7%) and lower transplant-related mortality (6.3% vs. 80%) for PRCA responders. Conclusions Standardized guidelines on when and how to treat PRCA are necessary because the current treatment is controversial among centers.
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Affiliation(s)
- Elisabetta Metafuni
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica e Ematologia; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Teresa Busnego Barreto
- Hematology and Hemotherapy Service, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Caterina Giovanna Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica e Ematologia; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Sabrina Giammarco
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica e Ematologia; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Assunta Limongiello
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica e Ematologia; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Federica Sorà
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica e Ematologia; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Bianchi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica e Ematologia; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giuseppina Massini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica e Ematologia; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Nicola Piccirillo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica e Ematologia; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Rossana Putzulu
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica e Ematologia; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Filippo Frioni
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Bacigalupo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica e Ematologia; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luciana Teofili
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica e Ematologia; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Patrizia Chiusolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica e Ematologia; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simona Sica
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica e Ematologia; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
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Longval T, Leprêtre AC, Ravinet A, Fayard A, Forcade E, Coman T, Redjoul R, Berceanu A, Buchbinder N, Berlie G, Mappoura M, Giannotti F, Chevillon F, Robin M, Peffault de Latour R, Sicre de Fontbrune F. Efficacy and safety of Daratumumab for the treatment of ABO-incompatible pure red cell aplasia after allogenic HSCT: report from SFGM-TC. Bone Marrow Transplant 2024; 59:893-895. [PMID: 38461290 DOI: 10.1038/s41409-024-02202-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/15/2023] [Accepted: 01/08/2024] [Indexed: 03/11/2024]
Affiliation(s)
- Thomas Longval
- Division of Hematology, Department of Oncology, Geneva University Hospitals, Geneva, Switzerland.
| | | | - Aurélie Ravinet
- Hematology Department, Centre Hospitalier Universitaire Estaing, Clermont-Ferrand, France
| | - Amandine Fayard
- Hematology Department, Centre Hospitalier Universitaire Estaing, Clermont-Ferrand, France
| | - Edouard Forcade
- Hematology Department, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Tereza Coman
- Hematology Department, Gustave-Roussy, Villejuif, France
| | - Rabah Redjoul
- Hematology Department, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ana Berceanu
- Hematology Department, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Nimrod Buchbinder
- Hematopoietic Pediatric Transplant Center, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | | | - Maria Mappoura
- Division of Hematology, Department of Oncology, Geneva University Hospitals, Geneva, Switzerland
| | - Federica Giannotti
- Division of Hematology, Department of Oncology, Geneva University Hospitals, Geneva, Switzerland
| | - Florian Chevillon
- Hematology Adolescents and Young Adults, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Marie Robin
- Hematology Transplant Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Régis Peffault de Latour
- Hematology Transplant Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Flore Sicre de Fontbrune
- Hematology Transplant Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
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Vo AK, Hervig T, Reikvam H. Pure red cell aplasia after hematopoietic stem cell transplantation - experimental therapeutic approaches. Expert Opin Investig Drugs 2022; 31:881-884. [PMID: 35975626 DOI: 10.1080/13543784.2022.2113055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Not relevant.
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Affiliation(s)
- Anh Khoi Vo
- Section Hematology, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Tor Hervig
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Irish Blood Transfusion Service, Dublin, Ireland
| | - Håkon Reikvam
- Section Hematology, Department of Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
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Arslan S, Ali H, Mei M, Marcucci G, Forman S, Nakamura R, Stein A, Al Malki MM. Successful treatment of refractory pure red cell aplasia in major ABO-mismatched allogeneic hematopoietic stem cell transplant with single agent Ibrutinib. Bone Marrow Transplant 2022; 57:830-833. [PMID: 35194155 DOI: 10.1038/s41409-022-01590-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Shukaib Arslan
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California, USA.
| | - Haris Ali
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California, USA
| | - Mathew Mei
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California, USA
| | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California, USA
| | - Stephan Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California, USA
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California, USA
| | - Anthony Stein
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California, USA
| | - Monzr M Al Malki
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California, USA
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Daratumumab may be the most effective treatment for post-engraftment pure red cell aplasia due to persistent anti-donor isohemagglutinins after major ABO-mismatched allogeneic transplantation. Bone Marrow Transplant 2021; 57:282-285. [PMID: 34711914 PMCID: PMC8552208 DOI: 10.1038/s41409-021-01507-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/05/2021] [Accepted: 10/13/2021] [Indexed: 12/02/2022]
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