title: Alemtuzumab plus cyclosporine treatment of the autoimmune hemolytic anemia in an adult bowel transplant.
abstract: An adult male underwent a bowel transplant for tufting enteropathy, receiving alemtuzumab, tacrolimus, and steroids as immunosuppressants. Five years later, he developed an autoimmune hemolytic anemia (AIHA), anti-IgG positive, with reduced reticulocyte count, leukopenia, and thrombocytopenia with antiplatelet antibodies. After an unsuccessful initial treatment with high dose steroids, reduction in tacrolimus dose, and intravenous immunoglobulin (IVIG), a bone marrow biopsy revealed absence of erythroid maturation with precursor hyperplasia. The patient was switched to sirolimus and received four doses of rituximab plus two courses of plasmapheresis, which decreased his transfusion requirements. After a febrile episode one month later, the AIHA relapsed with corresponding decreases in platelet and leukocyte count: cyclosporine A (CsA) was started with a second course of rituximab and IVIG without response, even though repeat bone marrow biopsy did not reveal morphology correlated to an acquired pure red cell aplasia (APRCA). Considering the similarity in his clinical and laboratory findings to APRCA, alemtuzumab was added (three doses over a week) with CsA followed by steroids. The patient was eventually discharged transfusion-independent, with increasing hemoglobin (Hb) levels and normal platelet and leukocyte count. One year later he is still disease-free with functioning graft.
authors.affiliation: Liver and Multiorgan Transplant Unit, Sant'Orsola-Malpighi University Hospital, 40138 Bologna, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Lauro
authors.affiliation: Institute of Hematology "L. e A. Seràgnoli", Sant'Orsola-Malpighi University Hospital, 40138 Bologna, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Stanzani
authors.affiliation: Institute of Hematology "L. e A. Seràgnoli", Sant'Orsola-Malpighi University Hospital, 40138 Bologna, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Finelli
authors.affiliation: Liver and Multiorgan Transplant Unit, Sant'Orsola-Malpighi University Hospital, 40138 Bologna, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Zanfi
authors.affiliation: Liver and Multiorgan Transplant Unit, Sant'Orsola-Malpighi University Hospital, 40138 Bologna, Italy.
authors.forename: M C
authors.initials: MC
authors.lastname: Morelli
authors.affiliation: Liver and Multiorgan Transplant Unit, Sant'Orsola-Malpighi University Hospital, 40138 Bologna, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Pasqualini
authors.affiliation: Liver and Multiorgan Transplant Unit, Sant'Orsola-Malpighi University Hospital, 40138 Bologna, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Dazzi
authors.affiliation: Liver and Multiorgan Transplant Unit, Sant'Orsola-Malpighi University Hospital, 40138 Bologna, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Ravaioli
authors.affiliation: Liver and Multiorgan Transplant Unit, Sant'Orsola-Malpighi University Hospital, 40138 Bologna, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Di Simone
authors.affiliation: Immunohematology Service and Blood Bank, Sant'Orsola-Malpighi University Hospital, 40138 Bologna, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Giudice
authors.affiliation: Center for Chronic Intestinal Failure, Sant'Orsola-Malpighi University Hospital, 40138 Bologna, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Pironi
authors.affiliation: Liver and Multiorgan Transplant Unit, Sant'Orsola-Malpighi University Hospital, 40138 Bologna, Italy.
authors.forename: A D
authors.initials: AD
authors.lastname: Pinna