Fatal immune-mediated pancytopenia and a TRALI-like syndrome associated with high titers of recipient-type antibodies against donor-derived peripheral blood cells after allogeneic bone marrow transplantation following dose reduced conditioning

Tuebingen University Hospital, Dept. of Hematology/Oncology, Otfried-Mueller-Str. 10, 72076 Tuebingen, Germany. stefan.knop@med.uni-tuebingen.de Pancytopenia occurring after bone marrow transplantation is a rare complication. A 47 year old patient with progression of multiple myeloma after standard...

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Bibliographic Details
Published in:Haematologica (Roma) 2004-05, Vol.89 (5), p.ECR12-ECR12
Main Authors: Knop, S, Bux, J, Kroeber, SM, Bader, P, Hebart, H, Kanz, L, Einsele, H
Format: Article
Language:English
Subjects:
Anemia, Hemolytic, Autoimmune - immunology
Animals
Autoantibodies - blood
Blood Cells - immunology
Bone Marrow Transplantation - adverse effects
Bone Marrow Transplantation - immunology
Fatal Outcome
Histocompatibility
HLA Antigens - immunology
Humans
Male
Middle Aged
Multiple Myeloma - immunology
Multiple Myeloma - therapy
Pancytopenia - immunology
Rabbits
Respiratory Distress Syndrome, Adult - immunology
Transplantation Conditioning - methods
Transplantation, Homologous
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Summary:Tuebingen University Hospital, Dept. of Hematology/Oncology, Otfried-Mueller-Str. 10, 72076 Tuebingen, Germany. stefan.knop@med.uni-tuebingen.de Pancytopenia occurring after bone marrow transplantation is a rare complication. A 47 year old patient with progression of multiple myeloma after standard therapy received an allogeneic marrow graft from a matched unrelated donor. The non-myeloablative conditioning regimen consisted of fludarabine, cyclophosphamide, rabbit anti-thymocyte globulin and total body irradiation. GVHD prophylaxis consisted of cyclosporine. Neutrophil engraftment was as expected and the patient was discharged without signs of acute GvHD. On day +34 the patient presented with clinical and laboratory findings consistent with severe pancytopenia. Antibodies against red cells, platelets, lymphocytes and granulocytes were detected in extremely high titers. Immune-mediated pancytopenia was refractory on multiple immunosuppressive treatment strategies. Proliferation of polyclonal plasma cells of recipient-type that was documented postmortem, was most likely responsible for excessive antibody formation.
ISSN:0390-6078
1592-8721