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Pure red cell aplasia after a major ABO-mismatched bone marrow transplant for chronic myeloid leukaemia: response to re-introduction of cyclosporin

Bone Marrow Transplantation volume 33, pages 459–461 (2004)Cite this article

Bone marrow transplantation in the setting of incompatibility between donor ABO antigens and the recipient immune system (major ABO incompatibility) is associated with specific immunohaematological complications.1 These include acute and delayed haemolysis and delayed onset of donor erythropoiesis. Pure red cell aplasia (PRCA) has been reported to occur in about 15% of HLA-matched major ABO-incompatible pairs.2 Most cases are felt to be due to the persistence of high-titre host antidonor isohaemagglutinins inhibiting donor erythropoiesis. A role for cell-mediated immune mechanisms has been suggested, where titres are low or absent.3

We report a case of PRCA following a major ABO-incompatible BMT, where the aplasia persisted after the withdrawal of cyclosporin employed for graft-versus-host-disease prophylaxis. On the basis of persistent mixed chimaerism and minimal isohaemagglutinin titres, cyclosporin was re-introduced in order to treat a presumed T-cell-mediated inhibition of donor erythropoiesis. Erythroid engraftment rapidly ensued and was promptly followed by the switch to a complete donor chimeric state.

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Authors and Affiliations

  1. Department of Haematology, St. James's Hospital, 8, Dublin, Ireland

    P J Hayden, N Gardiner, K Molloy, M Lawler & S R McCann

  2. University of Dublin, Trinity College, 1, Dublin, Ireland

    P J Hayden, J Ryan, M Lawler & S R McCann

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  1. P J Hayden
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  2. N Gardiner
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  3. K Molloy
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  5. M Lawler
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Hayden, P., Gardiner, N., Molloy, K. et al. Pure red cell aplasia after a major ABO-mismatched bone marrow transplant for chronic myeloid leukaemia: response to re-introduction of cyclosporin. Bone Marrow Transplant 33, 459–461 (2004). https://doi.org/10.1038/sj.bmt.1704366

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