title: Rituximab, plasma exchange and intravenous immunoglobulins as a new treatment strategy for severe HLA alloimmune platelet refractoriness.
abstract: Platelet refractoriness (PR) due to HLA alloimmunization is a common and serious complication of patients receiving long-term packed red blood cell and platelet transfusions. Although most alloimmunized patients will respond to HLA-matched platelets, 20-50% of patients will remain refractory even to matched platelets. Several measures have been reported to overcome this complication, such as intravenous immunoglobulins (IVIG), plasma exchange (PE), protein A column therapy, or rituximab. We report a woman with acute myeloid leukemia secondary to myelodysplastic syndrome who was diagnosed with PR because of HLA alloimmunization. Due to difficulties in finding HLA-compatible platelet donors by cross-reactive groups in our panel of HLA-typed platelet donors, the patient received treatment with rituximab, PEs and IVIG. With this treatment strategy, the presence of HLA antibodies decreased from a panel-reactive antibody (PRA) of 89-0%. This allowed the performance of hematopoietic progenitor cell transplantation with random donor platelets. Rituximab, PE, and IVIG may be an option to overcome severe PR due to poly-specific HLA alloimmunization.
authors.affiliation: Apheresis Unit, Department of Hemotherapy and Hemostasis, CDB, IDIBAPS, Hospital Clínic, University of Barcelona , Spain and.
authors.forename: Joan
authors.initials: J
authors.lastname: Cid
authors.forename: Laura
authors.initials: L
authors.lastname: Magnano
authors.forename: Maria
authors.initials: M
authors.lastname: Acosta
authors.forename: Cristina
authors.initials: C
authors.lastname: Alba
authors.forename: Jordi
authors.initials: J
authors.lastname: Esteve
authors.forename: Miguel
authors.initials: M
authors.lastname: Lozano
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D016824:Antigens, Human Platelet / Q000276:immunology*; D001791:Blood Platelet Disorders / Q000097:blood / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors / Q000627:therapeutic use*; D008875:Middle Aged; D010951:Plasma Exchange; D010976:Platelet Count; D017713:Platelet Transfusion / Q000009:adverse effects*; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D016824:Antigens, Human Platelet; D006680:HLA Antigens; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D000069283:Rituximab
keywords: HLA alloimmunization; intravenous immunoglobulins; plasma exchange; platelet refractoriness; rituximab