Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.
Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
Acta Haematol. 2021;144(6):683-687. doi: 10.1159/000515257. Epub 2021 Apr 22.
Pure red cell aplasia (PRCA) can potentially occur after allogeneic hematopoietic stem cell transplantation (allo-HSCT) if recipient and donor ABO blood groups are mismatched, with the recipient having isoagglutinins against the donor blood group. Patient plasma cells that survive transplant conditioning produce anti-ABO isoagglutinins targeting donor erythroid precursors in the bone marrow and thus causing red cell aplasia. Therapeutic options include steroids, discontinuation of immunosuppression, plasmapheresis, donor lymphocyte infusion, rituximab, and bortezomib, all with limited benefit. Daratumumab utilized in the treatment of multiple myeloma is an anti-CD38 monoclonal antibody targeting plasma cells, which makes it a potentially efficient therapy for PRCA. The current case report presents a patient with post-allo-HSCT PRCA cured with daratumumab applied after failure of other therapies. Our findings demonstrate safety and high efficiency of daratumumab, suggesting its applicability as early treatment of post-allo-HSCT PRCA.
纯红细胞再生障碍性贫血（PRCA）在异基因造血干细胞移植（allo-HSCT）后，如果受者和供者 ABO 血型不匹配，且受者存在针对供者血型的同种凝集素，则可能发生。移植预处理后存活的患者浆细胞产生针对供者骨髓中红细胞前体的抗 ABO 同种凝集素，从而导致红细胞再生障碍。治疗选择包括类固醇、免疫抑制药物停药、血浆置换、供者淋巴细胞输注、利妥昔单抗和硼替佐米，但均疗效有限。达雷妥尤单抗用于多发性骨髓瘤的治疗，是一种针对浆细胞的抗 CD38 单克隆抗体，使其成为 PRCA 的潜在有效治疗方法。本病例报告介绍了一名患者在 allo-HSCT 后发生 PRCA，在其他治疗失败后应用达雷妥尤单抗治疗后痊愈。我们的研究结果表明达雷妥尤单抗具有安全性和高效性，提示其作为 allo-HSCT 后 PRCA 的早期治疗具有适用性。
