title: Autoimmune hemolysis and immune thrombocytopenic purpura after cord blood transplantation may be life-threatening and warrants early therapy with rituximab.
abstract: Autoimmune hemolysis (AH) and immune thrombocytopenic purpura (ITP) are recognized complications after cord blood transplantation (CBT). We evaluated the incidence and characteristics of AH/ITP after double-unit CBT in a day 100 landmark analysis of 152 patients (median age 36 years, range 0.9-70 years) transplanted for hematologic malignancies with myeloablative or nonmyeloablative conditioning and calcineurin inhibitor (CNI)/mycophenolate mofetil. With a median 5.2-year (range 1.6-9.7 years) survivor follow-up, 10 patients developed autoimmune cytopenias (8 AH, 1 ITP, 1 both) at a median of 10.4 months (range 5.8-24.5) post CBT for a 7% cumulative incidence 3 years after the day 100 landmark. Six patients presented with severe disease (hemoglobin ⩽6 g/dL and/or platelets <20 × 109/L). All AH patients were direct antiglobulin test positive. All 10 cases developed during immunosuppression taper with 8 having prior acute GVHD. All 10 patients received rituximab 2-18 days after diagnosis, and corticosteroids combined with rituximab within <7 days was the most effective. No patient died of AH/ITP. AH/ITP occurs infrequently after CBT but may be life-threatening requiring emergency therapy. Rituximab combined with corticosteroids at diagnosis is warranted in patients with severe disease.
authors.affiliation: Department of Pharmacy, New York, NY, USA.
authors.forename: V
authors.initials: V
authors.lastname: Bhatt
authors.affiliation: Adult Bone Marrow Transplantation Service, Department of Medicine, New York, NY, USA.
authors.forename: L
authors.initials: L
authors.lastname: Shune
authors.affiliation: Adult Bone Marrow Transplantation Service, Department of Medicine, New York, NY, USA.
authors.forename: E
authors.initials: E
authors.lastname: Lauer
authors.affiliation: Adult Bone Marrow Transplantation Service, Department of Medicine, New York, NY, USA.
authors.forename: M
authors.initials: M
authors.lastname: Lubin
authors.affiliation: Department of Epidemiology and Biostatistics, New York, NY, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Devlin
authors.affiliation: Bone Marrow Transplantation Service, Department of Pediatrics, New York, NY, USA.
authors.forename: A
authors.initials: A
authors.lastname: Scaradavou
authors.affiliation: Division of Hematology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: R
authors.initials: R
authors.lastname: Parameswaran
authors.affiliation: Adult Bone Marrow Transplantation Service, Department of Medicine, New York, NY, USA.|Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Perales
authors.affiliation: Adult Bone Marrow Transplantation Service, Department of Medicine, New York, NY, USA.|Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Ponce
authors.affiliation: Division of Hematology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: S
authors.initials: S
authors.lastname: Mantha
authors.affiliation: Bone Marrow Transplantation Service, Department of Pediatrics, New York, NY, USA.
authors.forename: N A
authors.initials: NA
authors.lastname: Kernan
authors.affiliation: Adult Bone Marrow Transplantation Service, Department of Medicine, New York, NY, USA.|Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: J N
authors.initials: JN
authors.lastname: Barker
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000744:Anemia, Hemolytic, Autoimmune / Q000188:drug therapy / Q000209:etiology*; D000074322:Antineoplastic Agents, Immunological / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects*; D016638:Critical Illness; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000150:complications* / Q000628:therapy; D006461:Hemolysis; D006801:Humans; D007165:Immunosuppression Therapy; D007223:Infant; D008297:Male; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy / Q000209:etiology*; D000069283:Rituximab / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000074322:Antineoplastic Agents, Immunological; D000069283:Rituximab