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Autoimmune thrombocytopenia with clonal expansion of CD8-positive T cells after autologous peripheral blood stem cell transplantation for diffuse large B-cell lymphoma

Bone Marrow Transplantation volume 35, pages 315–316 (2005)Cite this article

Thrombocytopenia, a common complication of autologous hematopoietic stem cell transplantation (auto-HSCT) can occur immediately or later after engraftment. While various pathophysiological mechanisms may be involved, including poor hematological recovery and different infections, autoimmune thrombocytopenia has been reported only a few times and appears to be a rarity.1,2,3 Hequet et al3 reported six cases (2.0%) of autoimmune thrombocytopenia among 307 auto-HSCT cases.3 Altered immune reconstitution after auto-HSCT may promote immunological dysregulation predisposing autoimmune disorders. However, the mechanism of autoimmune thrombocytopenia occurring after auto-HSCT is insufficiently characterized. We report a patient who developed apparent autoimmune thrombocytopenia with clonal expansion of CD8-positive T cells following autologous peripheral blood stem cell transplantation (auto-PBSCT to treat an aggressive B-cell lymphoma.

In April 2003, a 61-year-old Japanese man was diagnosed with non-Hodgkin's lymphoma of diffuse large B-cell type. The International Prognostic Index was high, that is, poor prognosis reflecting relatively advanced age, clinical stage IVb, an elevated serum lactate dehydrogenase concentration, and more than two extranodal sites involved. He had no previous history of autoimmune disease and was seronegative for HIV. After three courses of CHOP chemotherapy (cyclophosphamide 750 mg/m2 × 1, adriamycin 50 mg/m2 × 1, vincristine 1.4 mg/m2 × 1, and prednisolone 100 mg × 5), the patient achieved complete remission (CR). Given the high risk of relapse and the chemosensitivity of the disease, he was considered an appropriate candidate for high-dose chemotherapy followed by auto-PBSCT. PBSC were collected after high-dose mobilization chemotherapy (etoposide 500 mg/m2 × 3) followed by granulocyte-colony stimulating factor (G-CSF). Nucleated cells totaling 0.35 × 109/kg, including 13.7 × 106/kg CD34-positive cells, were obtained and frozen after 2 days of apheresis, during hematologic recovery. Subsequently, three additional courses of CHOP chemotherapy were given and he remained in CR.

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Authors and Affiliations

  1. Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Maidashi 3-1-1, Higashi-Ku, Fukuoka, 812-8582, Japan

    T Isobe, T E Tanimoto, G Nakaji, T Miyamoto, S Yamasaki, K Takase, A Numata, T Fukuda, K Nagafuji & M Harada

  2. Blood Transfusion Service, Kyushu University Hospital, Fukuoka, Japan

    T Miyamoto, S Yamasaki, A Numata & S Inaba

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  1. T Isobe
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  2. T E Tanimoto
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Isobe, T., Tanimoto, T., Nakaji, G. et al. Autoimmune thrombocytopenia with clonal expansion of CD8-positive T cells after autologous peripheral blood stem cell transplantation for diffuse large B-cell lymphoma. Bone Marrow Transplant 35, 315–316 (2005). https://doi.org/10.1038/sj.bmt.1704750

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