Successful treatment of pure red cell aplasia with a single dose of rituximab in a child after major ABO incompatible peripheral blood allogeneic stem cell transplantation for acquired aplastic anemia.
Pure red cell aplasia (PRCA) is a well-known although infrequent hematologic complication after allogeneic bone marrow transplantation. PRCA occurs in cases of major ABO-mismatch between donor and recipient and is believed to be due to inhibition of donor erythroid progenitors by residual host isohemagglutinins. We report a 10-year-old boy with post-hepatitis aplastic anemia (AA) who developed PRCA after HLA-matched familial peripheral blood stem cell transplantation (SCT) following conditioning with Cph 200 mg/kg + ATG 90 mg/kg. Granulocyte engraftment occurred on day +18, platelet engrafted on day +40, while reticulocytopenia at 0% persisted until day +118, and erythroid precursors were totally absent from bone marrow. After a single dose of rituximab 200 mg/m(2)administered on day +118 PRCA resolved and on day +132 the reticulocytes rose to 5.7%. On day +139 the Hb reached 137 g/l and the erythroid lineage in BM increased to 21%. We conclude that due to the rapid recovery from PRCA and lack of side effects, rituximab should be tried as first-line treatment of PRCA after allo-SCT.
Maschan
A A
AA
Research Institute for Pediatric Hematology of the Russian Federation, Russian Children's Hospital, Moscow, Russian Federation.
Skorobogatova
E V
EV
Balashov
D N
DN
Pashanov
E D
ED
Trakhtman
P E
PE
Schipitzina
I P
IP
Skvortsova
Y V
YV
Rumiantzev
A G
AG
D000017:ABO Blood-Group System / Q000276:immunology; D000741:Anemia, Aplastic / Q000150:complications / Q000209:etiology / Q000628:therapy*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D058846:Antibodies, Monoclonal, Murine-Derived; D001787:Blood Group Incompatibility; D002648:Child; D018572:Disease-Free Survival; D006505:Hepatitis / Q000150:complications; D006801:Humans; D008297:Male; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects*; D012010:Red-Cell Aplasia, Pure / Q000188:drug therapy* / Q000209:etiology; D000069283:Rituximab; D014184:Transplantation, Homologous / Q000276:immunology; D016896:Treatment Outcome
D000017:ABO Blood-Group System; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab