Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Dramatic response to rituximab in a child with severe cold autoimmune hemolytic anemia arising after allogeneic hematopoietic SCT

Bone Marrow Transplantation volume 45, pages 201–202 (2010)Cite this article

Autoimmune hemolytic anemia (AIHA) is a well-recognized complication following allogeneic hematopoietic SCT (HSCT). Compared with the incidence of one to two cases per 100 000 in the normal adult population,1 AIHA is estimated to occur in 3–5% of adult HSCT patients.2, 3 In the largest study of pediatric patients to date, published in 2004, the incidence of all types of AIHA was 6% at 1 year after transplant.4 The cause for this increased incidence post transplant is poorly understood, but is likely because of an incomplete reconstitution of the immune system and immune dysregulation. As has been observed in the adult HSCT patient population,2, 3 the majority of the pediatric patients are refractory to standard therapy for AIHA. As a result, the mortality rate is high (53%) because of hemolysis and infectious complications that develop as a consequence of the immunosuppressive treatments for AIHA.4

Autoimmune hemolytic anemia following HSCT is usually mediated by warm reactive, IgG autoantibodies. Cold reactive, IgM autoantibodies that have reactivity at 30 °C or higher can also cause clinically significant hemolysis, but this has been rarely described in the HSCT setting, with only two pediatric cases reported in the literature to our knowledge.5, 6 Little is known about the clinical course and optimal management of cold AIHA in the HSCT population, but in general, cold AIHA is not responsive to standard therapies such as steroids or splenectomy. In this report, we describe the successful treatment of a pediatric patient with severe cold AIHA following allogeneic HSCT, using rituximab.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

References

  1. Gehrs BC, Friedberg RC . Autoimmune hemolytic anemia. Am J Hematol 2002; 69: 258–271.

    Article  PubMed  Google Scholar 

  2. Drobyski WR, Potluri J, Sauer D, Gottschall JL . Autoimmune hemolytic anemia following T cell-depleted allogeneic bone marrow transplantation. Bone Marrow Transplant 1996; 17: 1093–1099.

    CAS  PubMed  Google Scholar 

  3. Chen FE, Owen I, Savage D, Roberts I, Apperley J, Goldman JM et al. Late onset haemolysis and red cell autoimmunization after allogeneic bone marrow transplant. Bone Marrow Transplant 1997; 19: 491–495.

    Article  CAS  PubMed  Google Scholar 

  4. O'Brien TA, Eastlund T, Peters C, Neglia JP, Defor T, Ramsay NK et al. Autoimmune haemolytic anaemia complicating haematopoietic cell transplantation in paediatric patients: high incidence and significant mortality in unrelated donor transplants for non-malignant diseases. Br J Haematol 2004; 127: 67–75.

    Article  PubMed  Google Scholar 

  5. Hongeng S, Tardtong P, Worapongpaiboon S, Ungkanont A, Jootar S . Successful treatment of refractory autoimmune haemolytic anaemia in a post-unrelated bone marrow transplant paediatric patient with rituximab. Bone Marrow Transplant 2002; 29: 871–872.

    Article  CAS  PubMed  Google Scholar 

  6. Azuma E, Nishihara H, Hanada M, Nagai M, Hiratake S, Komada Y et al. Recurrent cold hemagglutinin disease following allogeneic bone marrow transplantation successful treated with plasmapheresis, corticosteroid and cyclophosphamid. Bone Marrow Transplant 1996; 18: 243–246.

    CAS  PubMed  Google Scholar 

  7. Garvey B . Rituxumab in the treatment of autoimmune haematological disorders. Br J Haematol 2008; 141: 149–169.

    Article  CAS  PubMed  Google Scholar 

  8. Raj K, Narayanan S, Augustson B, Ho A, Mehta P, Duncan N et al. Rituximab is effective in the management of refractory autoimmune cytopenias occurring after allogeneic stem cell transplantation. Bone Marrow Transplant 2005; 36: 299–301.

    Article  Google Scholar 

  9. Ship A, May W, Lucas K . Anti-CD20 monoclonal antibody therapy for autoimmune hemolytic anemia following T cell-depleted, haplo-identical stem cell transplantation. Bone Marrow Transplant 2002; 29: 365–366.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Corti P, Bonanomi S, Vallinoto C, Balduzzi A, Uderzo C, Cazzaniga G et al. Rituximab for immune hemolytic anaemia following T and B cell depleted hematopoietic stem cell transplantation. Acta Haematol 2003; 109: 43–45.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric, Division of Hematology and Oncology at Mattel Children's Hospital at UCLA, Los Angeles, CA, USA

    T Simms-Waldrip, A Ikeda & T Moore

  2. Department of Pathology, Division of Transfusion Medicine at Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA

    D Goldfinger & S Yuan

  3. David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    T Simms-Waldrip, A Ikeda, D Goldfinger, T Moore & S Yuan

Authors
  1. T Simms-Waldrip
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A Ikeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D Goldfinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T Moore
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S Yuan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T Simms-Waldrip.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Simms-Waldrip, T., Ikeda, A., Goldfinger, D. et al. Dramatic response to rituximab in a child with severe cold autoimmune hemolytic anemia arising after allogeneic hematopoietic SCT. Bone Marrow Transplant 45, 201–202 (2010). https://doi.org/10.1038/bmt.2009.108

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2009.108

This article is cited by

Search

Advanced search

Quick links