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.

  • Correspondence
  • Published:

Autoimmune cytopenias following pediatric hematopoietic cell transplant

Bone Marrow Transplantation volume 59, pages 117–120 (2024)Cite this article

Subjects

Development of an autoimmune cytopenia (AIC) after hematopoietic cell transplant (HCT) is an uncommon, potentially devastating complication in pediatric patients. The most common post-HCT AIC is autoimmune hemolytic anemia (AIHA), which has an incidence of 2.4–6% [1, 2]. Autoimmune neutropenia (AIN) and immune thrombocytopenic purpura (ITP) are rarely reported.

Previously reported clinical risk factors for development of AIHA post- HCT include non-malignant transplant indication, chronic graft-versus-host disease (GVHD), absence of total body irradiation (TBI) in conditioning regimen, unrelated donor, cord blood transplant, and peripheral blood stem cell transplant [1, 3,4,5,6,7].

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

Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

References

  1. Neunert CE, Despotovic JM. Autoimmune hemolytic anemia and immune thrombocytopenia following hematopoietic stem cell trans- plant: a critical review of the literature. Pediatr Blood Cancer. 2019;66:e27569.

    Article  CAS  PubMed  Google Scholar 

  2. Ahmed I, Teruya J, Murray-Krezan C, Krance R. The incidence of autoimmune hemolytic anemia in pediatric hematopoietic stem cell recepients post-first and post-second hematopoietic stem cell transplant. Pediatr Transplant. 2015;19:391–8.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Horn B, Viele M, Mentzer W, Mogck N, DeSantes K, Cowan M. Autoimimune hemolytic anemia in patients with SCID after T cell-depleted BM and PBSC transplantation. Bone Marrow Transplant. 1999;24:1009–13.

    Article  CAS  PubMed  Google Scholar 

  4. Gaziev J, Isgrò A, Sodani P, Paciaroni K, De Angelis G, Marziali M, et al. Haploidentical HSCT for hemoglobinopathies: improved outcomes with TCR alpha beta(+)/CD19(+)-depleted grafts. Blood Adv. 2018;2:263.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Page KM, Mendizabal AM, Prasad VK, Martin PL, Parikh S, Wood S, et al. Posttransplant autoim- mune hemolytic anemia and other autoimmune cytopenias are increased in very young infants undergoing unrelated donor umbilical cord blood transplantation. Biol Blood Marrow Transplant. 2008;14:1108–17.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kruizinga MD, van Tol MJD, Bekker V, Netelenbos T, Smiers FJ, Bresters D, et al. Risk factors, treatment, and immune dysregulation in autoimmune cytopenia after allogeneic hematopoietic stem cell transplantation in pediatric patients. Biol Blood Marrow Transplant. 2018;24:772–8.

    Article  CAS  PubMed  Google Scholar 

  7. Neely JA, Dvorak CC, Pantell MS, Melton A, Huang JN, Shimano KA. Autoimmune cytopenias in pediatric hematopoietic cell transplant patients. Front Pediatr. 2019;7:171.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Hillier K, Harris EM, Berbert L, Pai SY, Grace RF. Characteristics and outcomes of autoimmune hemolytic anemia after pediatric allogeneic stem cell transplant. Pediatric Blood Cancer. 2022;69:e29410. https://doi.org/10.1002/pbc.29410.

    Article  PubMed  Google Scholar 

  9. Neunert C, Terrell DR, Arnold DM, Buchana G, Cines DB, Cooper N, et al. American society of hematology 2019 guidelines for immune thrombocytopenia. Blood Adv. 2019;3:3829–66.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Newburger PE. Autoimmune and other acquired neutropenias. Hemato Am Soc Hematol Educ Program. 2016;1:38–42.

    Article  Google Scholar 

  11. Hill A, Hill AQ. Autoimmune hemolytic anemia. Hematol Am Soc Hematol Educ Program. 2018;1:382–9.

    Article  Google Scholar 

  12. O’Brien TA, Eastlund T, Peters C, Neglia JP, Defor T, Ramsay NKC, et al. Autoimmune haemolytic anaemia complicating haematopoietic cell transplantation in pediatric 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 

  13. Faraci M, Zecca M, Pillon M, Rovelli A, Menconi MC, Ripaldi M, et al. Autoimmune hematological diseases after allogeneic hematopoietic stem cell transplantation in children: an Italian multicenter experience. Biol Blood Marrow Transplant. 2014;20:272–8.

    Article  PubMed  Google Scholar 

  14. Chang T-Y, Jaing T-H, Wen Y-C, Huang IA, Chen SH, Tsay PK. Risk factor analysis of autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation in children. Medicine (Baltimore). 2016;95:e5396.

    Article  PubMed  Google Scholar 

  15. Hwang-Bo S, Kim S-K, Lee JW, Jang PS, Chung NG, Jeong DC, et al. Treatment and response of autoimmune cytopenia occurring after allogeneic hematopoietic cell transplantation in children. Blood Res. 2017;52:119–24.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Kristin Mara, MS, for her invaluable statistical analysis.

Author information

Authors and Affiliations

  1. Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA

    Jacob R. Greenmyer & Asma Ali

  2. Pediatric Hematology and Oncology, Mayo Clinic, Rochester, MN, USA

    Jacob R. Greenmyer, Shakila Khan, Alexis Kuhn, Catherine Martin, Asmaa Ferdjallah & Mira Kohorst

  3. Hospice and Palliative Medicine, Mayo Clinic, Rochester, MN, USA

    Sydney Ariagno

  4. Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, USA

    Lindy Pence & Mary O’Shea

  5. Transfusion Medicine, Mayo Clinic, Rochester, MN, USA

    Lauren A. Greenmyer

  6. Pediatric Pharmacy, Mayo Clinic, Rochester, MN, USA

    Alexis Kuhn & Catherine Martin

Authors
  1. Jacob R. Greenmyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sydney Ariagno
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Asma Ali
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lindy Pence
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mary O’Shea
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lauren A. Greenmyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shakila Khan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Alexis Kuhn
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Catherine Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Asmaa Ferdjallah
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Mira Kohorst
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MK and JRG contributed to study protocol, extracted data, performed statistical analysis, and wrote the report. SA, AA, LP, MO, and LAG extracted data and wrote the report. SK, AK, CM and AF contributed to study protocol, analyzed data, and wrote the report.

Corresponding author

Correspondence to Mira Kohorst.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Greenmyer, J.R., Ariagno, S., Ali, A. et al. Autoimmune cytopenias following pediatric hematopoietic cell transplant. Bone Marrow Transplant 59, 117–120 (2024). https://doi.org/10.1038/s41409-023-02116-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41409-023-02116-y

Search

Advanced search

Quick links