Successful treatment of refractory immune hemolysis following unrelated cord blood transplant with Campath-1H.
Immune-mediated hemolytic anemia is a well-recognized complication of hematopoietic stem cell transplantation. We report on a 6-year-old boy with X-linked adrenoleukodystrophy who developed severe delayed alloimmune hemolytic anemia associated with immune-mediated neutropenia and thrombocytopenia following major ABO incompatible unrelated cord blood transplantation. The patient's cytopenias were refractory to treatment with corticosteroids, cyclosporine, intravenous immune globulin, rituximab, and pentostatin. After one course of Campath-1H his hematologic parameters normalized, suggesting that the compound may be an effective therapy for complex immunohematologic disorders complicating hematopoietic stem cell transplantation. The case also emphasizes the importance of T-cells in transplant associated immune cytopenias.
Chao
Mwe Mwe
MM
Department of Pediatrics, Division of Pediatric Hematology-Oncology and Blood and Marrow Transplantation, University of Michigan Health System, Ann Arbor, Michigan, USA.
Levine
John E
JE
Ferrara
James L
JL
Cooling
Laura
L
Cooke
Kenneth R
KR
Hutchinson
Raymond J
RJ
Yanik
Gregory A
GA
D000326:Adrenoleukodystrophy / Q000628:therapy*; D000074323:Alemtuzumab; D000744:Anemia, Hemolytic, Autoimmune / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001787:Blood Group Incompatibility; D002648:Child; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects*; D005312:Fetal Blood / Q000637:transplantation; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D009503:Neutropenia / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D000970:Antineoplastic Agents; D000074323:Alemtuzumab; D008775:Methylprednisolone