title: Acquired immune cytopenias post-cardiac transplantation respond to rituximab.
abstract: Hematologic abnormalities following solid organ transplantation are infrequently autoimmune in origin. We present a series of autoimmune cytopenias developing as a late complication of pediatric cardiac transplantation. Autoimmune cytopenias represented include autoimmune hemolytic anemia, acquired Glanzmann thrombasthenia, and idiopathic thrombocytopenic purpura. Standard therapies were used in each patient without sustainable results. Eventually, each patient was treated with and responded to rituximab. In this report, we review these cases, propose potential mechanisms for development of autoimmune cytopenias, and discuss our experience with rituximab in managing refractory autoimmune cytopenias.
authors.affiliation: Division of Hematology/Oncology, Children's Hospital Boston, Dana Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Venée N
authors.initials: VN
authors.lastname: Tubman
authors.forename: Leslie
authors.initials: L
authors.lastname: Smoot
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Heeney
mesh_terms: D000741:Anemia, Aplastic / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology; D000744:Anemia, Hemolytic, Autoimmune / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20 / Q000276:immunology; D001323:Autoantibodies / Q000096:biosynthesis; D001327:Autoimmune Diseases / Q000188:drug therapy* / Q000276:immunology; D001402:B-Lymphocytes / Q000187:drug effects; D009202:Cardiomyopathies / Q000601:surgery; D002313:Cardiomyopathy, Restrictive / Q000150:complications; D002648:Child; D003327:Coronary Disease / Q000150:complications; D004341:Drug Evaluation; D017809:Fatal Outcome; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D010322:Parvoviridae Infections / Q000150:complications; D011183:Postoperative Complications / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology; D011241:Prednisone / Q000627:therapeutic use; D000069283:Rituximab; D013915:Thrombasthenia / Q000188:drug therapy* / Q000276:immunology
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D001323:Autoantibodies; D016756:Immunoglobulins, Intravenous; D000069283:Rituximab; D011241:Prednisone