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Daratumumab in the Management of Red Cell Aplasia Following Allogeneic Hematopoietic Stem Cell Transplantation.
Eur J Haematol
February 2025
Hans Messner Allogeneic Blood and Marrow Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Hospital, Toronto, Canada.
Pure red cell aplasia (PRCA) is a rare but significant complication following major ABO-incompatible allogeneic hematopoietic stem cell transplantation (HSCT). The persistence of recipient B lymphocytes producing anti-donor isohemagglutinins leads to reticulocytopenia and anemia, often resulting in transfusion dependence. Current treatment options for post-HSCT PRCA are limited and frequently yield suboptimal responses, complicating patient management.
View Article and Find Full Text PDFProlonged Thrombocytopenia and Severe Transfusion Reaction after ABO-Incompatible Allogeneic Hematopoietic Stem Cell Transplantation in a Patient with Chronic Myelomonocytic Leukemia.
Transfus Med Hemother
October 2024
Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany.
Article Synopsis
- Major ABO-incompatible hematopoietic stem cell transplantation (allo-HCT) can lead to serious complications, including prolonged thrombocytopenia and increased need for platelet transfusions due to persistent anti-donor isoagglutinins.
- A 55-year-old male with chronic myelomonocytic leukemia experienced significant transfusion reactions after receiving A Rh(D)-negative platelets following his major incompatible allo-HCT.
- Modifying his platelet transfusion strategy to include only O Rh(D)-negative donors effectively reduced transfusion needs and eliminated reactions, highlighting the importance of isoagglutinin monitoring.
Glycolysis Changes in Alloreactive Memory B Cells in Highly Sensitized Kidney Transplant Recipients Undergoing Desensitization Therapy.
Transpl Int
July 2024
University Grenoble Alpes, CNRS, Inserm, CHU Grenoble Alpes, Institute for Advanced Biosciences, Grenoble, France.
Despite the growing use of desensitization strategies, hyperimmune patients remain at high risk of antibody-mediated rejection suggesting that, even when donor-specific antibodies (DSA) are effectively depleted, anti-donor specific B cells persist. We included 10 highly sensitized recipients that underwent desensitization with plasmapheresis and B cell depletion prior to kidney transplantation. We quantified changes in DSA (luminex), total B-cell subsets (flow cytometry), anti-donor HLA B cells (fluorospot), and single-cell metabolism in serially collected samples before desensitization, at the time of transplant, and at 6 and 12 months thereafter.
View Article and Find Full Text PDFCase report: Successful treatment with daratumumab for pure red cell aplasia in a patient with mixed lymphoid chimerism after ABO-mismatched stem cell transplant for sickle cell disease.
Front Immunol
July 2023
Department of Hematology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, Netherlands.
Article Synopsis
- Pure red cell aplasia (PRCA) is a serious complication that can occur after ABO-mismatched hematopoietic stem cell transplantation (HSCT), largely due to the immune response against donor ABO antigens.
- There is currently no standard treatment for post-transplant PRCA, but the anti-CD38 monoclonal antibody daratumumab has shown promise, as demonstrated in a case where it successfully treated a patient with mixed chimerism.
- The case highlights that, with increasing applications of non-myeloablative HSCT for sickle cell disease, the incidence of PRCA may rise, making it essential for clinicians to consider daratumumab as an effective treatment option for mixed chimerism patients at risk for
Prevalence of Pure Red Cell Aplasia Following Major ABO-Incompatible Hematopoietic Stem Cell Transplantation.
Front Immunol
April 2022
Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Background: Pure red cell aplasia (PRCA) is one of the important complications in major ABO-incompatible allogeneic hematopoietic stem cell transplantation (HSCT). The established pathogenic factor of PRCA is the persistence of high anti-donor isohemagglutinins. As previously verified, the conditioning regimen and donor type were the factors associated with the development of PRCA in the small-sized studies.
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