title: Resistant pure red cell aplasia after allogeneic stem cell transplantation with major ABO mismatch treated by escalating dose donor leukocyte infusion.
abstract: We report a case of pure red cell aplasia (PRCA) following allogeneic stem cell transplantation (SCT) with major ABO mismatch which proved resistant to all standard treatment options such as change in immunosuppressive treatment, high-dose erythropoietin (EPO) or plasma exchange. We therefore proceeded to administer five cycles of Rituximab therapy, without success. Finally, escalating doses of donor-derived leukocyte infusion (DLI) resolved the PRCA of our patient 415 d after bone-marrow transplantation (BMT) and 140 d after the first infusion of donor leukocytes. A review of the literature shows the efficacy of various treatments; the role of DLI and other treatment options are discussed. Furthermore, the underlying pathophysiological mechanisms especially with regard to the role of NK cells in alloreactivity after allogeneic SCT are explained.
authors.affiliation: Service d'Hématologie, Hôpital Cantonal Universitaire de Genève, Geneva, Switzerland. frank.verholen@hcuge.ch
authors.forename: F
authors.initials: F
authors.lastname: Verholen
authors.forename: M
authors.initials: M
authors.lastname: Stalder
authors.forename: C
authors.initials: C
authors.lastname: Helg
authors.forename: Y
authors.initials: Y
authors.lastname: Chalandon
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001787:Blood Group Incompatibility / Q000150:complications*; D001803:Blood Transfusion; D003131:Combined Modality Therapy; D003561:Cytarabine / Q000008:administration & dosage; D004351:Drug Resistance; D004921:Erythropoietin / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D015255:Idarubicin / Q000008:administration & dosage; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007694:Killer Cells, Natural / Q000276:immunology; D015479:Leukemia, Myelomonocytic, Acute / Q000188:drug therapy / Q000628:therapy; D017708:Leukocyte Transfusion; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D012010:Red-Cell Aplasia, Pure / Q000209:etiology* / Q000276:immunology / Q000503:physiopathology / Q000628:therapy; D012074:Remission Induction; D000069283:Rituximab; D014184:Transplantation, Homologous / Q000009:adverse effects* / Q000276:immunology
chemical_list: D000017:ABO Blood-Group System; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007166:Immunosuppressive Agents; D003561:Cytarabine; D004921:Erythropoietin; D000069283:Rituximab; D015255:Idarubicin