CD34+-enriched donor lymphocyte infusions in a case of pure red cell aplasia and late graft failure after major ABO-incompatible bone marrow transplantation.
A variety of immunohematological complications may occur after ABO-incompatible BMT. We report a CML patient (blood group O) who received a BMT from an HLA-identical sibling (blood group AB). The transplant was followed by normal myeloid and megakaryocytic engraftment, but erythroblastopenia persisted for more than 200 days after BMT. By bone marrow culture studies, a complement-dependent serum inhibitor of hemopoiesis was detected, suggesting immunological inhibition of erythropoiesis. The patient was resistant to a number of treatments such as intravenous gamma-globulins, prednisolone and high-dose erythropoietin. Full engraftment with normal blood counts and marrow cellularity was achieved after two dose-escalating CD34+-enriched donor lymphocyte infusions (DLI). This experience suggests that CD34+-enriched DLI may be an effective treatment for patients with delayed engraftment or late graft failure due to major ABO-incompatibility.
Division of Hematology, Federico II University Medical School, Naples, Italy.
C
C
Selleri
A
A
Raiola
G
G
De Rosa
L
L
Luciano
L
L
Pezzullo
M
M
Picardi
B
B
Rotoli
D000017:ABO Blood-Group System; D000328:Adult; D018952:Antigens, CD34 / Q000097:blood*; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D005260:Female; D006084:Graft Rejection / Q000628:therapy*; D006801:Humans; D015466:Leukemia, Myeloid, Chronic-Phase / Q000628:therapy; D017710:Lymphocyte Transfusion; D008297:Male; D012010:Red-Cell Aplasia, Pure / Q000209:etiology / Q000628:therapy*; D014019:Tissue Donors
D000017:ABO Blood-Group System; D018952:Antigens, CD34