title: Successful treatment of severe immune hemolytic anemia after allogeneic stem cell transplantation with bortezomib: report of a case and review of literature.
abstract: BACKGROUND
  Immune hemolytic anemia is a well-known complication after allogeneic hematopoietic stem cell transplantation (HSCT). Posttransplant hemolytic anemia results in increased red blood cell transfusions and medical sequelae including iron overload.
  
  
  METHODS
  We present a case report of immune hemolytic anemia that occurred after allogeneic HSCT from an ABO major-mismatched, HLA-matched unrelated donor. The patient had high anti-donor A type antibodies that were unresponsive to treatment with steroids and rituximab, resulting in persistent transfusion dependence. A detailed time course of anti-A titers, plasma cell content of the marrow, and B-cell content of the blood is presented. Treatment with bortezomib, a protease inhibitor, eliminated residual host-type plasma cells secreting anti-A and restored normal donor-derived erythropoiesis.
  
  
  CONCLUSIONS
  This report, and a review of literature for treatment of immune hemolytic anemia after allogeneic HSCT, supports the utility of bortezomib as plasma cell-targeted therapy in this setting.
authors.affiliation: Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Sakura
authors.initials: S
authors.lastname: Hosoba
authors.forename: David L
authors.initials: DL
authors.lastname: Jaye
authors.forename: Cynthia
authors.initials: C
authors.lastname: Cohen
authors.forename: John D
authors.initials: JD
authors.lastname: Roback
authors.forename: Edmund K
authors.initials: EK
authors.lastname: Waller
mesh_terms: D064591:Allografts; D000744:Anemia, Hemolytic, Autoimmune / Q000097:blood / Q000628:therapy*; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001897:Boronic Acids / Q000008:administration & dosage*; D000069286:Bortezomib; D004920:Erythropoiesis; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D010950:Plasma Cells / Q000378:metabolism / Q000473:pathology; D011719:Pyrazines / Q000008:administration & dosage*; D020127:Recovery of Function
chemical_list: D000970:Antineoplastic Agents; D001897:Boronic Acids; D011719:Pyrazines; D000069286:Bortezomib