title: Fatal immune-mediated pancytopenia and a TRALI-like syndrome associated with high titers of recipient-type antibodies against donor-derived peripheral blood cells after allogeneic bone marrow transplantation following dose reduced conditioning.
abstract: Pancytopenia occurring after bone marrow transplantation is a rare complication. A 47 year old patient with progression of multiple myeloma after standard therapy received an allogeneic marrow graft from a matched unrelated donor. The non-myeloablative conditioning regimen consisted of fludarabine, cyclophosphamide, rabbit anti-thymocyte globulin and total body irradiation. GVHD prophylaxis consisted of cyclosporine. Neutrophil engraftment was as expected and the patient was discharged without signs of acute GvHD. On day +34 the patient presented with clinical and laboratory findings consistent with severe pancytopenia. Antibodies against red cells, platelets, lymphocytes and granulocytes were detected in extremely high titers. Immune-mediated pancytopenia was refractory on multiple immunosuppressive treatment strategies. Proliferation of polyclonal plasma cells of recipient-type that was documented postmortem, was most likely responsible for excessive antibody formation.
authors.affiliation: Tuebingen University Hospital, Dept. of Hematology/Oncology, Otfried-Mueller-Str. 10, 72076 Tuebingen, Germany. stefan.knop@med.uni-tuebingen.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Knop
authors.forename: Juergen
authors.initials: J
authors.lastname: Bux
authors.forename: Stefan M
authors.initials: SM
authors.lastname: Kroeber
authors.forename: Peter
authors.initials: P
authors.lastname: Bader
authors.forename: Holger
authors.initials: H
authors.lastname: Hebart
authors.forename: Lothar
authors.initials: L
authors.lastname: Kanz
authors.forename: Hermann
authors.initials: H
authors.lastname: Einsele
mesh_terms: D000744:Anemia, Hemolytic, Autoimmune / Q000276:immunology*; D000818:Animals; D001323:Autoantibodies / Q000097:blood*; D001773:Blood Cells / Q000276:immunology*; D016026:Bone Marrow Transplantation / Q000009:adverse effects* / Q000276:immunology; D017809:Fatal Outcome; D006680:HLA Antigens / Q000276:immunology; D006648:Histocompatibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000276:immunology / Q000628:therapy; D010198:Pancytopenia / Q000276:immunology*; D011817:Rabbits; D012128:Respiratory Distress Syndrome / Q000276:immunology*; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous
chemical_list: D001323:Autoantibodies; D006680:HLA Antigens