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Transplant Toxicities

Autoimmune hemolysis and immune thrombocytopenic purpura after cord blood transplantation may be life-threatening and warrants early therapy with rituximab

Bone Marrow Transplantation volume 51, pages 1579–1583 (2016)Cite this article

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Abstract

Autoimmune hemolysis (AH) and immune thrombocytopenic purpura (ITP) are recognized complications after cord blood transplantation (CBT). We evaluated the incidence and characteristics of AH/ITP after double-unit CBT in a day 100 landmark analysis of 152 patients (median age 36 years, range 0.9–70 years) transplanted for hematologic malignancies with myeloablative or nonmyeloablative conditioning and calcineurin inhibitor (CNI)/mycophenolate mofetil. With a median 5.2-year (range 1.6–9.7 years) survivor follow-up, 10 patients developed autoimmune cytopenias (8 AH, 1 ITP, 1 both) at a median of 10.4 months (range 5.8–24.5) post CBT for a 7% cumulative incidence 3 years after the day 100 landmark. Six patients presented with severe disease (hemoglobin ⩽6 g/dL and/or platelets <20 × 109/L). All AH patients were direct antiglobulin test positive. All 10 cases developed during immunosuppression taper with 8 having prior acute GVHD. All 10 patients received rituximab 2–18 days after diagnosis, and corticosteroids combined with rituximab within <7 days was the most effective. No patient died of AH/ITP. AH/ITP occurs infrequently after CBT but may be life-threatening requiring emergency therapy. Rituximab combined with corticosteroids at diagnosis is warranted in patients with severe disease.

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Acknowledgements

This work was supported, in part, by the Gabrielle’s Angel Foundation for Cancer Research (to JNB), the Society of Memorial Sloan Kettering Cancer Center (to JNB and SG), the Memorial Sloan Kettering Cancer Center Translational and Integrative Medicine Research Program (to JNB), P01 CA23766 from the National Cancer Institute, National Institutes of Health and the Memorial Sloan Kettering Cancer Center Support Grant/Core Grant (P30 CA008748).

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Authors and Affiliations

  1. Department of Pharmacy, New York, NY, USA

    V Bhatt

  2. Department of Medicine, Adult Bone Marrow Transplantation Service, New York, NY, USA

    L Shune, E Lauer, M Lubin, M A Perales, D M Ponce & J N Barker

  3. Department of Epidemiology and Biostatistics, New York, NY, USA

    S M Devlin

  4. Department of Pediatrics, Bone Marrow Transplantation Service, New York, NY, USA

    A Scaradavou & N A Kernan

  5. Division of Hematology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    R Parameswaran & S Mantha

  6. Department of Medicine, Weill Cornell Medical College, New York, NY, USA

    M A Perales, D M Ponce & J N Barker

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  1. V Bhatt
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  2. L Shune
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  3. E Lauer
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  4. M Lubin
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  11. N A Kernan
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Correspondence to V Bhatt or J N Barker.

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Bhatt, V., Shune, L., Lauer, E. et al. Autoimmune hemolysis and immune thrombocytopenic purpura after cord blood transplantation may be life-threatening and warrants early therapy with rituximab. Bone Marrow Transplant 51, 1579–1583 (2016). https://doi.org/10.1038/bmt.2016.228

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