Relapse of Aplastic Anemia with Majority Donor Chimerism (Donor-Type Aplasia) Occurring Late after Bone Marrow Transplantation.

Autor: Shaw A; Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford, United Kingdom., Passweg JR; Department of Haematology, University Hospital Basel, Basel, Switzerland., De La Fuente J; Department of Paediatrics, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom., Bajwa R; Department of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio., Stein J; Hemato-Oncology Department, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel., Al-Zaben A; Paediatric Haematology Oncology and Stem Cell Transplantation, King Abdullah University Hospital, Amman, Jordan., Halkes CJM; Department of Haematology, Leiden University Medical Centre, Leiden, The Netherlands., Norton A; Department of Haematology, Birmingham Children's Hospital, Birmingham, United Kingdom., Cummins M; Bone Marrow Transplant Unit, Royal Hospital for Children, Bristol, United Kingdom., Moppett JP; Bone Marrow Transplant Unit, Royal Hospital for Children, Bristol, United Kingdom., Shanap MA; Bone Marrow and Stem Cell Transplantation Program, King Hussein Cancer Centre, Amman, Jordan., Steward CG; Bone Marrow Transplant Unit, Royal Hospital for Children, Bristol, United Kingdom. Electronic address: colin.steward@bristol.ac.uk.
Jazyk: angličtina
Zdroj: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation [Biol Blood Marrow Transplant] 2020 Mar; Vol. 26 (3), pp. 480-485. Date of Electronic Publication: 2019 Nov 13.
DOI: 10.1016/j.bbmt.2019.11.010
Abstrakt: There have been sporadic reports of the development of delayed disease recurrence after bone marrow transplantation for severe aplastic anemia despite sustained majority or full donor chimerism. This is termed "donor-type aplasia" (DTA). We describe the management and outcome of 11 pediatric patients from 8 institutions in Europe, the United States, and the Middle East who developed DTA at a mean of 35 months post-transplant. These patients were initially transplanted at a mean age of 10.0 years (range, 5.8 to 16.0 years), 9 from matched sibling donors and 2 from matched unrelated donors. Attempts to treat DTA with varying combinations of additional immunosuppression (including intravenous immunoglobulin, donor lymphocyte infusions, stem cell boosts, and other therapies) failed. Ten patients have received a conditioned second transplant, 9 from the same donor and 1 from a new matched unrelated donor. Aplasia has resolved in the remaining patient in response to ongoing eltrombopag therapy. All patients were alive at a mean of 92 months (range, 26 to 195) after a second transplant; 6 are in complete remission, but 4 suffered from second/recurrent DTA at 16 to 129 months after retransplant and required further transplant therapy.
(Copyright © 2019 American Society for Transplantation and Cellular Therapy. All rights reserved.)
Databáze: MEDLINE
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