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Successful remission of chronic, refractory autoimmune thrombocytopenic purpura following non-myeloablative allogeneic stem cell transplantation

Bone Marrow Transplantation volume 31, pages 621–622 (2003)Cite this article

A 56-year-old female was referred to the Royal Brisbane Hospital for consideration of further management of chronic, refractory autoimmune thrombocytopenic purpura (AITP) initially diagnosed in 1965. Bone marrow examination at this time demonstrated increased number of morphologically normal megakaryocytes, consistent with peripheral sequestration or destruction. Antiplatelet antibodies were not performed. Her disease had been steroid dependent for 19 consecutive years prior to her referral to this institution in March 2001, maintaining platelet counts of 20–30 × 109/l. Degenerative joint disease of the hips bilaterally left her narcotic-dependent and wheel-chair bound. Total hip replacements could be offered if platelet increment could be guaranteed preoperatively. Prior therapies had consisted of intravenous immunoglobulin, with brief partial responses; laparoscopic splenectomy in 1998, with no improvement; and a 6-month trial of cyclosporin in 1999, with no appreciable increment in platelet counts.

Stem-cell transplantation utilising a nonablative conditioning regimen (fludarabine 25 mg/m2 Day −5 to Day −2 + TBI 2 Gy) with an HLA-matched brother, proceeded in April 2001. By Day 19, myeloid engraftment was established. Chimerism studies by X-Y FISH demonstrated 99% donor chimerism of CD3 positive cells. Platelet count was 15–20 × 109/l with second-daily platelet support. At Day 28, she was re-admitted with profound pancytopenia. Repeat chimerism studies now revealed only 2% donor population. Graft rejection had occurred with subsequent autologous reconstitution. Platelet count was now 2–3 × 109/l despite daily multidonor platelet infusions.

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Authors and Affiliations

  1. Haematology/Bone Marrow Transplantation Registrar Royal Brisbane Hospital, Queensland, Australia

    J P Butler

  2. Bone Marrow Transplantation Unit Royal Brisbane Hospital, Queensland, Australia

    S T S Durrant

  3. Clinical Haematologist The Holy Spirit Hospital Brisbane, Queensland, Australia

    T Frost

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  1. J P Butler
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  2. S T S Durrant
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  3. T Frost
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Butler, J., Durrant, S. & Frost, T. Successful remission of chronic, refractory autoimmune thrombocytopenic purpura following non-myeloablative allogeneic stem cell transplantation. Bone Marrow Transplant 31, 621–622 (2003). https://doi.org/10.1038/sj.bmt.1703897

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  • DOI: https://doi.org/10.1038/sj.bmt.1703897

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