AUTOIMMUNE HEMOLYTIC-ANEMIA FOLLOWING T-CELL-DEPLETED ALLOGENEIC BONE-MARROW TRANSPLANTATION

The development of immune-mediated hemolytic anemia is a well-recogniz ed complication after allogeneic bone marrow transplantation (BMT). Th e majority of reported cases, however, have been alloimmune in origin due to ABO or minor red blood cell antigen incompatibilities between t he donor and recipient. In this study, we report seven adult patients who developed autoimmune hemolytic anemia (AIHA) between June 1985 and January 1993. These patients were identified from a total of 236 adul t patients who received T cell-depleted (TCD) grafts as graft-versus-h ost disease (GVHD) prophylaxis. The onset of AIHA was at a median of 1 0 months (range 7-25 months) post-transplant and occurred in 5% of all patients transplanted with TCD grafts who survived at least 6 months. Six patients had a warm reacting autoantibody, while one patient had a cold-reacting antibody with a thermal amplitude up to 30 degrees C. All were receiving immunosuppressive treatment for GVHD at the time of diagnosis, Initial treatment in all patients consisted of steroids. T hree of the seven had a partial response while the four remaining pati ents failed to respond to corticosteroids. Splenectomy was performed i n three patients with two partial responses. Four patients were treate d with additional therapeutic interventions, including plasmapheresis, immunoglobulin infusions, staphylococcus protein A column, or other i mmunosuppressive agents. In five cases, erythropoietin was administere d as adjunctive treatment to maintain adequate hematocrit levels. Two patients are presently in complete remission after prolonged courses o f steroids, while a third patient has compensated hemolysis requiring low-dose steroids. Four patients died due to either infectious complic ations or disseminated intravascular coagulation secondary to cold agg lutinin disease. These data indicate that AIHA is a clinically signifi cant and not infrequent complication in allogeneic marrow transplant r ecipients. The response to conventional treatment is generally unsatis factory as even patients who ultimately remit require prolonged course s of immunosuppressive therapy.