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Antileukemic immunity associated with antineutrophil antibody production after allogeneic hematopoietic SCT for myeloid/NK-cell precursor acute leukemia

Bone Marrow Transplantation volume 42, pages 285–287 (2008)Cite this article

An important therapeutic mechanism of allogeneic hematopoietic SCT (HSCT) is the antileukemic immune response, the so-called GVL effect, which is thought to be mediated mainly by alloreactive T and natural killer cells.1 As a consequence of immunological disturbance after HSCT, autoimmune hemolytic anemia, immune thrombocytopenia and autoimmune neutropenia (AIN) are sometimes observed in association with GVHD.2 However, the relationship between GVHD, GVL effect and autoimmune disorders is poorly understood. Here, we present a rare case of the simultaneous occurrence of severe AIN and a smoldering relapse of myeloid/natural killer-cell precursor acute leukemia after allogeneic HSCT. Interestingly, immunocytochemical studies revealed serum reactivity to leukemic cells, indicating the direct suppressive effects of autoantibodies on leukemic cells. This report illustrates the possibility of a novel mechanism of the GVL effect mediated by autoantibody generation.

Although a clinical relapse of leukemia was recognized, the administration of intensive chemotherapy was withheld because of the persistent, severe cytopenia. Therefore, treatment for autoimmune cytopenia was attempted first. We chose high-dose dexamethasone therapy (40 mg/body, peroral, days 1–4) followed by prednisolone at 5 mg/day. One cycle of the high-dose dexamethasone therapy rapidly increased the platelet count to 100 × 109/l, and the hemoglobin level also elevated. After the second cycle, the neutrophil count temporarily increased up to 0.35 × 109/l but soon fell, and this time leukemic infiltration became prominent in the peripheral blood and BM. As GIIFT showed that ANA had almost completely disappeared from the patient's serum at this point, the decreased neutrophil count was thought to be due to leukemic infiltration. After salvage chemotherapy, consisting of cytarabine, etoposide and mitoxantrone, CR was confirmed and the neutrophil count increased to more than 0.5 × 109/l for the first time after the onset of neutropenia.

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Authors and Affiliations

  1. Department of Hematology and Oncology, University of Tokyo Hospital, Tokyo, Japan

    H I Suzuki, T Suzuki, H Sato, A Hangaishi, T Takahashi, Y Kanda, T Motokura & M Kurokawa

  2. Department of Transfusion Medicine, University of Tokyo Hospital, Tokyo, Japan

    A Kamijo

  3. Department of Pathology, University of Tokyo Hospital, Tokyo, Japan

    S Oota

  4. Department of Cell Therapy and Transplantation Medicine, University of Tokyo Hospital, Tokyo, Japan

    S Chiba

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  1. H I Suzuki
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  3. A Kamijo
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  11. M Kurokawa
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Correspondence to M Kurokawa.

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Suzuki, H., Suzuki, T., Kamijo, A. et al. Antileukemic immunity associated with antineutrophil antibody production after allogeneic hematopoietic SCT for myeloid/NK-cell precursor acute leukemia. Bone Marrow Transplant 42, 285–287 (2008). https://doi.org/10.1038/bmt.2008.158

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