title: Autoimmune cytopenias after umbilical cord blood transplantation in adults with hematological malignancies: a single-center experience.
abstract: We describe incidence, clinical features, serological data, response to therapy and outcome of autoimmune cytopenias (ACs), including autoimmune hemolytic anemia (AIHA) and autoimmune thrombocytopenia (AIT) in a series of 281 consecutive adults with hematological malignancies that received single-unit umbilical cord blood transplantation (UCBT) at a single institution. AIHA was diagnosed in 15 patients at a median time of 181 days (range, 25-543), 12 of them had cold antibodies (IgM). The 3-year cumulative incidence (CI) of AIHA was 5.4% (CI 95% 2.7-8.1). Concomitant infections at the time of AIHA were present in 10 patients. Five out of nine patients that received corticosteroids achieved either a PR or a CR, whereas six out of eight patients that received rituximab responded. Four patients developed AIT giving a 3-year CI of 1.4% (CI 95% 0-2.8), concomitant infections were present in three of them. Multivariable analysis showed that development of chronic GVHD (relative risk (RR) 4; 95% CI 1.1-13.7; P=0.03) and diagnosis of CML (RR 4.3; 95% CI 1.5-12.7; P=0.008) were associated with an increased risk of AC. In conclusion, AIHA and AIT are relevant and clinically significant complications in UCBT recipients, especially among those that develop chronic GVHD. Response to therapy is sub-optimal, and rituximab should be considered as a therapeutic option, in this setting were most patients had cold AIHA and a serological profile similar to that seen in cold agglutinin disease.
authors.affiliation: Servicio de Hematología, Hospital Universitari i politècnic La Fe, Valencia, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Sanz
authors.affiliation: Servicio de Hematología, Hospital Universitari i politècnic La Fe, Valencia, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Arango
authors.affiliation: Servicio de Hematología, Hospital Universitari i politècnic La Fe, Valencia, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Carpio
authors.affiliation: Servicio de Hematología, Hospital Universitari i politècnic La Fe, Valencia, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Montesinos
authors.affiliation: Servicio de Hematología, Hospital Universitari i politècnic La Fe, Valencia, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Moscardó
authors.affiliation: Servicio de Hematología, Hospital Universitari i politècnic La Fe, Valencia, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Martín
authors.affiliation: Servicio de Hematología, Hospital Universitari i politècnic La Fe, Valencia, Spain.
authors.forename: F
authors.initials: F
authors.lastname: López
authors.affiliation: Servicio de Hematología, Hospital Universitari i politècnic La Fe, Valencia, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Jarque
authors.affiliation: Servicio de Hematología, Hospital Universitari i politècnic La Fe, Valencia, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Lorenzo
authors.affiliation: Servicio de Hematología, Hospital Universitari i politècnic La Fe, Valencia, Spain.
authors.forename: J
authors.initials: J
authors.lastname: de la Rubia
authors.affiliation: Servicio de Hematología, Hospital Universitari i politècnic La Fe, Valencia, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Solves
authors.affiliation: Servicio de Hematología, Hospital Universitari i politècnic La Fe, Valencia, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Boluda
authors.affiliation: Servicio de Hematología, Hospital Universitari i politècnic La Fe, Valencia, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Salazar
authors.affiliation: Servicio de Hematología, Hospital Universitari i politècnic La Fe, Valencia, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Cañigral
authors.affiliation: Servicio de Hematología, Hospital Universitari i politècnic La Fe, Valencia, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Sanz
authors.affiliation: Servicio de Hematología, Hospital Universitari i politècnic La Fe, Valencia, Spain.
authors.forename: G F
authors.initials: GF
authors.lastname: Sanz
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D064591:Allografts; D000744:Anemia, Hemolytic, Autoimmune / Q000188:drug therapy / Q000209:etiology; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage*; D002908:Chronic Disease; D036101:Cord Blood Stem Cell Transplantation; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000209:etiology; D019337:Hematologic Neoplasms / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy / Q000209:etiology; D012189:Retrospective Studies; D000069283:Rituximab
chemical_list: D000305:Adrenal Cortex Hormones; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab