Autoimmune hemolysis and immune thrombocytopenic purpura after cord blood transplantation may be life-threatening and warrants early therapy with rituximab Journal Article
| Authors: | Bhatt, V.; Shune, L.; Lauer, E.; Lubin, M.; Devlin, S. M.; Scaradavou, A.; Parameswaran, R.; Perales, M. A.; Ponce, D. M.; Mantha, S.; Kernan, N. A.; Barker, J. N. |
| Article Title: | Autoimmune hemolysis and immune thrombocytopenic purpura after cord blood transplantation may be life-threatening and warrants early therapy with rituximab |
| Abstract: | Autoimmune hemolysis (AH) and immune thrombocytopenic purpura (ITP) are recognized complications after cord blood transplantation (CBT). We evaluated the incidence and characteristics of AH/ITP after double-unit CBT in a day 100 landmark analysis of 152 patients (median age 36 years, range 0.9-70 years) transplanted for hematologic malignancies with myeloablative or nonmyeloablative conditioning and calcineurin inhibitor (CNI)/mycophenolate mofetil. With a median 5.2-year (range 1.6-9.7 years) survivor follow-up, 10 patients developed autoimmune cytopenias (8 AH, 1 ITP, 1 both) at a median of 10.4 months (range 5.8-24.5) post CBT for a 7% cumulative incidence 3 years after the day 100 landmark. Six patients presented with severe disease (hemoglobin <= 6 g/dL and/or platelets <20 x 10(9)/L). All AH patients were direct antiglobulin test positive. All 10 cases developed during immunosuppression taper with 8 having prior acute GVHD. All 10 patients received rituximab 2-18 days after diagnosis, and corticosteroids combined with rituximab within <7 days was the most effective. No patient died of AH/ITP. AH/ITP occurs infrequently after CBT but may be life-threatening requiring emergency therapy. Rituximab combined with corticosteroids at diagnosis is warranted in patients with severe disease. |
| Keywords: | anemia; adults; stem-cell transplantation; versus-host-disease; cytopenias; marrow-transplantation |
| Journal Title: | Bone Marrow Transplantation |
| Volume: | 51 |
| Issue: | 12 |
| ISSN: | 0268-3369 |
| Publisher: | Nature Publishing Group |
| Date Published: | 2016-12-01 |
| Start Page: | 1579 |
| End Page: | 1583 |
| Language: | English |
| ACCESSION: | WOS:000390759600007 |
| DOI: | 10.1038/bmt.2016.228 |
| PROVIDER: | wos |
| PUBMED: | 27643868 |
| PMCID: | PMC5338737 |
| Notes: | Article -- Source: Wos |
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