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Efficacy and safety of Daratumumab for the treatment of ABO-incompatible pure red cell aplasia after allogenic HSCT: report from SFGM-TC

Bone Marrow Transplantation (2024)Cite this article

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Pure Red Cell Aplasia (PRCA) after ABO-mismatched Hematopoietic Stem Cell Transplant (HSCT) remains a challenge for physicians. It occurs in 7 to 10% [1,2,3] of major or bi-directional ABO-incompatible HSCT. Although it does not affect overall survival [3, 4], post-transplant PRCA significantly impairs patients’ quality of life due to fatigue, iron-overload and increased risk of transfusion complications. Half of the patients resolve PRCA within six months after transplant but others experience prolonged PRCA with no decrease of their isohemagglutinin titers. There is an unmet medical need for these patients’, as no treatment has yet demonstrated efficacy [3, 4]. Moreover, the scarcity of PRCA cases results in a lack of prospective data.

Among other strategies, plasma cell targeted therapies seem the most promising approach given that the physiology of prolonged PRCA is presumably a reflection of residual host plasma cell clones [5] producing isohemagglutinins. Daratumumab is a humanized monoclonal antibody targeting CD38, commonly used to treat plasma cell disorders. Since the first report in 2018 by Chapuy et al. [6] of PRCA recovery after 6 weekly Daratumumab infusions, ten other successful cases have been reported [7,8,9,10,11,12,13,14] with variations in the management of Daratumumab. In their letter, Martino et al. [14] provide a comprehensive review of published case reports. Here, we further contribute to this field by presenting a systematic report of PRCA patients treated in centers affiliated with the Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC).

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Data availability

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

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Authors and Affiliations

  1. Division of Hematology, Department of Oncology, Geneva University Hospitals, Geneva, Switzerland

    Thomas Longval, Maria Mappoura & Federica Giannotti

  2. Établissement Français du Sang (EFS), Saint-Louis Hospital, Paris, France

    Anne-Claire Leprêtre

  3. Hematology Department, Centre Hospitalier Universitaire Estaing, Clermont-Ferrand, France

    Aurélie Ravinet & Amandine Fayard

  4. Hematology Department, Centre Hospitalier Universitaire de Bordeaux, Pessac, France

    Edouard Forcade

  5. Hematology Department, Gustave-Roussy, Villejuif, France

    Tereza Coman

  6. Hematology Department, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Paris, France

    Rabah Redjoul

  7. Hematology Department, Centre Hospitalier Universitaire de Besançon, Besançon, France

    Ana Berceanu

  8. Hematopoietic Pediatric Transplant Center, Centre Hospitalier Universitaire de Rouen, Rouen, France

    Nimrod Buchbinder

  9. Établissement Français du Sang (EFS), Clermont-Ferrand, France

    Guillaume Berlie

  10. Hematology Adolescents and Young Adults, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France

    Florian Chevillon

  11. Hematology Transplant Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France

    Marie Robin, Régis Peffault de Latour & Flore Sicre de Fontbrune

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  1. Thomas Longval
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  16. Flore Sicre de Fontbrune
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Consortia

the Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC)

  • Members

    • Marie Robin
    • , Edouard Forcade
    • , Flore Sicre de Fontbrune
    • , Régis Peffault de Latour
    • , Florian Chevillon
    • , Ana Berceanu
    • , Tereza Coman
    • , Aurélie Ravinet
    •  & Amandine Fayard

  • Non-members

    • Thomas Longval
    • , Federica Giannotti
    • , Maria Mappoura
    • , Nimrod Buchbinder
    • , Guillaume Berlie
    • , Anne-Claire Leprêtre
    •  & Rabah Redjoul

Contributions

TL and FSdF designed, performed the research and wrote the manuscript. TL, FSdF, AR, AF, EF, TC, RR, AB, NB, GB, MM, FG, FC, MR helped to collect the data. FG, RPdL helped to write the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Thomas Longval or Flore Sicre de Fontbrune.

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The authors declare no competing interests.

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Longval, T., Leprêtre, AC., Ravinet, A. et al. Efficacy and safety of Daratumumab for the treatment of ABO-incompatible pure red cell aplasia after allogenic HSCT: report from SFGM-TC. Bone Marrow Transplant (2024). https://doi.org/10.1038/s41409-024-02202-9

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  • DOI: https://doi.org/10.1038/s41409-024-02202-9

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