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Non-relapse cytopenias following allogeneic stem cell transplantation, a case based review

Abstract

The development of non-relapse cytopenias (NRC) is a relatively common occurrence post allogeneic stem cell transplant (alloSCT). Whilst there have been attempts to classify post alloSCT cytopenias by transplantation groups, ambiguity of definitions in prior publications compounded by a lack of availability of high-quality evidence, provide challenges to clinicians attempting to manage these complex patients. In this review we describe 3 cases of NRC, (1) Graft Failure with graft rejection representing cytopenias with minimal donor chimerism (2) Poor Graft Function representing cytopenias with complete donor chimerism and (3) Cytopenias with mixed donor chimerism. This case-based review will evaluate the currently available evidence regarding the pathophysiology of each entity as well as the evidence for current therapies with the aim of providing guidance to clinicians managing these complex patients.

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Fig. 1: Classification for Non-relapse Cytopenias following alloSCT based on level of donor chimerism.
Fig. 2: Blood counts (left y axis) and Chimerism (right y axis) for all cases presented.

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Acknowledgements

This work was supported by the Victorian State Government acting through the Victorian Cancer Agency and Maddie Riewoldt's Vision.

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AP drafted the manuscript JS, LC, and DR provided expert review of clinical literature relevant to the topic. RK provided expert review of scientific literature relevant to the topic.

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Correspondence to Ashvind Prabahran.

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Prabahran, A., Koldej, R., Chee, L. et al. Non-relapse cytopenias following allogeneic stem cell transplantation, a case based review. Bone Marrow Transplant (2022). https://doi.org/10.1038/s41409-022-01761-z

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