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Post-transplant induction of donor-type anti-RhD antibodies production shortly followed by complete hemolysis of recipient-type erythrocytes in RhD-mismatched allogeneic bone marrow recipient

Bone Marrow Transplantation volume 37, pages 433–434 (2006)Cite this article

Pre-existing anti-RhD-alloantibodies in allogeneic bone marrow donors are relatively seldom observed and may lead to hemolytic post transplant complications in RhD-mismatched recipients. We describe an HLA-matched sibling bone marrow transplant with RhD-mismatch and presence of pre-formed anti-RhD-alloantibodies in the donor. The recipient was a 58-year-old RhD-positive female with AML M2 FAB morphology, 46XX, FLT3(+), diagnosed 9 months before, in CR1 achieved after two induction chemotherapy courses, then followed by two consolidation chemotherapy courses and maintenance therapy. The donor was her HLA-matched 57-year-old RhD-negative sister who had been pregnant in the past and who tested anti-RhD-antibody positive in titer 1 (and anti-RhC-antibody in titer 32). ABO was compatible in donor and recipient.

Myeloablative conditioning consisted of Treosulfan 14 g/m2/day on days from −6 to −4, Fludarabine 30 mg/m2/day on days from −6 to −2. Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine-A 3 mg/kg/day and methotrexate 15 mg/m2 on day +1 and 10 mg/m2 on days +3, +6 and +11. Transplanted bone marrow after centrifugation and removal of anti-RhD-antibodies positive plasma contained 3.0 × 108 NC/kg, 3.0 × 106 CD34+ cells/kg and 35.0 × 106 CD3+ cells/kg.

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Authors and Affiliations

  1. Department of Hematology and Bone Marrow Transplantation, Silesian Medical Academy, Katowice, Poland

    M Markiewicz, J Wojnar, S Giebel, I Wyleżoł & J Hołowiecki

  2. Beskidzkie Centrum Onkologii, Bielsko-Biała, Poland

    A Wieczorkiewicz

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  1. M Markiewicz
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  2. J Wojnar
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  3. S Giebel
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  4. A Wieczorkiewicz
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  5. I Wyleżoł
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  6. J Hołowiecki
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Markiewicz, M., Wojnar, J., Giebel, S. et al. Post-transplant induction of donor-type anti-RhD antibodies production shortly followed by complete hemolysis of recipient-type erythrocytes in RhD-mismatched allogeneic bone marrow recipient. Bone Marrow Transplant 37, 433–434 (2006). https://doi.org/10.1038/sj.bmt.1705254

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