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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MSK Authors
  1. Nancy Kernan
    369 Kernan
  2. Doris Ponce
    129 Ponce
  3. Miguel-Angel Perales
    365 Perales
  4. Juliet N Barker
    224 Barker
  5. Marissa N Lubin
    77 Lubin
  6. Sean McCarthy Devlin
    288 Devlin
  7. Valkal Bhatt
    32 Bhatt
  8. Simon H Mantha
    29 Mantha
  9. Leyla Osman Shune
    5 Shune
  10. Emily Jean Lauer
    15 Lauer