Clinical and serological characterization of autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation

Background Autoimmune hemolytic anemia （AIHA） is an uncommon complication of allogeneic hematopoietic stem cell transplantation （allo-HSCT） which has only been reported in a few cases.We here aimed to explore its mechanism.Methods We retrospectively analyzed 296 patients who underwent allo-HSCT in o...

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Bibliographic Details
Published in:Chinese medical journal 2014, Vol.127 (7), p.1235-1238
Main Authors: Yang, Zhen, Wu, Bangzhao, Zhou, Youning, Wang, Wenjuan, Chen, Suning, Sun, Aining, Wu, Depei, Xu, Yang
Format: Article
Language:English
Subjects:
Adolescent
Adrenal Cortex Hormones - therapeutic use
Adult
Anemia, Hemolytic, Autoimmune - diagnosis
Anemia, Hemolytic, Autoimmune - drug therapy
Anemia, Hemolytic, Autoimmune - etiology
Antibodies, Monoclonal, Murine-Derived - therapeutic use
Child
Child, Preschool
Female
Graft vs Host Disease - diagnosis
Graft vs Host Disease - drug therapy
Graft vs Host Disease - etiology
Hematopoietic Stem Cell Transplantation - adverse effects
Humans
IgM抗体
Male
Middle Aged
Retrospective Studies
Rituximab
Transplantation, Homologous - adverse effects
Young Adult
临床表现
异基因造血干细胞移植
溶血性贫血
激素治疗
移植物抗宿主病
自身免疫性
血清学鉴定
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Summary:Background Autoimmune hemolytic anemia （AIHA） is an uncommon complication of allogeneic hematopoietic stem cell transplantation （allo-HSCT） which has only been reported in a few cases.We here aimed to explore its mechanism.Methods We retrospectively analyzed 296 patients who underwent allo-HSCT in our center from July 2010 to July 2012.Clinical manifestations were carefully reviewed and the response to currently available treatment approaches were evaluated.The survival and risk factors of AIHA patients after allo-HSCT were further analyzed.Results Twelve patients were diagnosed with AIHA at a median time of 100 days （15-720 days） after allo-HSCT.The incidence of AIHA after allo-HSCT was 4.1％.IgG antibody were detected in ten patients and IgM antibody in two patients.The two cold antibody AIHA patients had a better response to steroid corticoid only treatment and the ten warm antibody AIHA patients responded to corticosteroid treatment and adjustment of immunosuppressant therapy.Rituximab was shown to be effective for AIHA patients who failed conventional therapy.Survival analysis showed that the combination of AIHA in allo-HSCT patients hinted at poor survival.Cytomegalovirus （CMV） infection,graft-versus-host disease （GVHD） and histocompatibility leukocyte antigen （HLA） mismatch seemed to increase the risk of developing AIHA.Conclusions Patients who develop AIHA after allo-HSCT have poor survival compared to non-AIHA patients.Possible risk factors of AIHA are CMV infection,GVHD,and HLA mismatch.Rituximab is likely to be the effective treatment choice for the refractory patients.
ISSN:0366-6999
2542-5641
DOI:10.3760/cma.j.issn.0366-6999.20132823