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Successful treatment of refractory pure red cell aplasia in major ABO-mismatched allogeneic hematopoietic stem cell transplant with single agent Ibrutinib

Bone Marrow Transplantation volume 57, pages 830–833 (2022)Cite this article

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Allogeneic hematopoietic stem cell transplant (allo-HCT) is a potentially curative treatment for several malignant and non-malignant hematological disorders. The basis of allo-HCT is the matching of human leukocyte antigen (HLA), which is encoded by major histocompatibility complex located on the short arm of chromosome 6 (6p21). ABO blood group results from glycosyltransferases encoded by a gene located on the long arm of chromosome 9 (9q34). The inheritance of ABO type is entirely independent of that of HLA. Unlike solid organ transplants, ABO blood group matching between the donor and the recipient is not a prerequisite for HCT. It is estimated that ~30–50% of all HCTs involve some form of ABO incompatibility between the donor and the recipient [1, 2].

Segregation of different types of ABO mismatch between the donor and the recipient is guided by the immune system [2]. If the recipient has an antibody, iso-agglutinin, against the donor’s red cell antigen, this type of mismatch is classified as a major ABO mismatch which occurs in about 20–25% of all HCTs [2]. The presence of high titer iso-agglutinins in the recipient can have post-transplant complications ranging from acute hemolysis, delayed red cell engraftment, and pure red cell aplasia (PRCA).

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Authors and Affiliations

  1. Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California, USA

    Shukaib Arslan, Haris Ali, Mathew Mei, Guido Marcucci, Stephan Forman, Ryotaro Nakamura, Anthony Stein & Monzr M. Al Malki

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Contributions

SA, AS, and MA designed research; all authors collected, assembled, analyzed, and interpreted data, SA and MA wrote the paper; and all authors approved the final version.

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Correspondence to Shukaib Arslan.

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The study was approved by the institutional Review Board (IRB). IRB # 21063.

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Arslan, S., Ali, H., Mei, M. et al. Successful treatment of refractory pure red cell aplasia in major ABO-mismatched allogeneic hematopoietic stem cell transplant with single agent Ibrutinib. Bone Marrow Transplant 57, 830–833 (2022). https://doi.org/10.1038/s41409-022-01590-0

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