Treatment and response of autoimmune cytopenia occurring after allogeneic hematopoietic cell transplantation in children
| Autor: | Pil-Sang Jang, Seongkoo Kim, Jae Wook Lee, Bin Cho, Hack-Ki Kim, Dae-Chul Jeong, Nack-Gyun Chung, Seok Hwang-Bo |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Evans syndrome Autoimmune cytopenia Gastroenterology 03 medical and health sciences 0302 clinical medicine hemic and lymphatic diseases Internal medicine medicine Autoimmune hemolytic anemia Blood type Hematopoietic cell transplantation business.industry Autoimmune Cytopenia Incidence (epidemiology) Hematology medicine.disease Immune thrombocytopenia Transplantation 030220 oncology & carcinogenesis Original Article Rituximab Complication business 030215 immunology medicine.drug |
| Zdroj: | Blood research |
| ISSN: | 2288-0011 2287-979X |
| DOI: | 10.5045/br.2017.52.2.119 |
| Popis: | Background Autoimmune cytopenia (AIC) is a rare complication of allogeneic hematopoietic cell transplantation (HCT). In this study, we reviewed the diagnosis, treatment and response to therapy for pediatric patients with post-HCT AIC at our institution. Methods Of the 292 allogeneic HCTs performed from January, 2011 to December, 2015 at the Department of Pediatrics, The Catholic University of Korea, seven were complicated by post-HCT AIC, resulting in an incidence of 2.4%. Results All seven patients with post-HCT AIC had received unrelated donor transplant. Six of seven patients had a major donor-recipient blood type mismatch. The subtypes of AIC were as follows: immune thrombocytopenia (ITP) 2, autoimmune hemolytic anemia (AIHA) 2, Evans syndrome 3. Median time from HCT to AIC diagnosis was 3.6 months. All but one patient responded to first line therapy of steroid±intravenous immunoglobulin (IVIG), but none achieved complete response (CR) with this treatment. After a median duration of treatment of 15.3 months, two patients with ITP achieved CR and five had partial response (PR) of AIC. Five patients were treated with rituximab, resulting in the following response: 2 CR, 2 PR, 1 no response (NR). Median time to response to rituximab was 26 days from first infusion. All patients are alive without event. Conclusion Post-HCT AIC is a rare complication that may not resolve despite prolonged therapy. Rapid initiation of second line agents including but not limited to B cell depleting treatment should be considered for those that fail to achieve CR with first line therapy. |
| Databáze: | OpenAIRE |
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