Red cell aplasia due to host type isohemagglutinins with exuberant red cell progenitor production of donor type in an ABO-mismatched allogeneic bone marrow transplant recipient.
ABO-mismatched bone marrow transplants have resulted in delayed red cell production in patients who have persistently elevated anti-ABO isohemagglutinin titers. We present a patient with chronic myelogenous leukemia who received an HLA-matched, ABO-incompatible bone marrow transplant from his sister. Post-transplant, he developed pure red cell aplasia with exuberant production of donor red cell precursors by in vitro BFU-E assay. Restriction fragment length polymorphism (RFLP) analysis of bone marrow, peripheral blood and BFU-E colonies demonstrated only donor type DNA post-transplant. However, the patient had persistently elevated isohemagglutinin titer and Ph1 chromosome-positive metaphases on chromosome analysis, indicating the presence of persistent host lymphocytes. With onset of acute graft vs. host disease (GVHD), the isohemagglutinin titer dropped, Ph1 chromosome-positive metaphases disappeared, and full hematopoietic recovery ensued. Longitudinal analysis of RFLP's, isohemagglutinin titers and chromosomes may be helpful in understanding the immunological interplay following allogeneic bone marrow transplantation.
Cockerill
K J
KJ
Division of Bone Marrow Transplantation, Pacific Presbyterian Medical Center, San Francisco, California.
Lyding
J
J
Zander
A R
AR
D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D015672:Erythroid Precursor Cells / Q000502:physiology*; D006086:Graft vs Host Disease / Q000209:etiology; D006388:Hemagglutinins / Q000032:analysis*; D006801:Humans; D008297:Male; D010677:Philadelphia Chromosome; D012010:Red-Cell Aplasia, Pure / Q000209:etiology*; D014184:Transplantation, Homologous
D000017:ABO Blood-Group System; D006388:Hemagglutinins