Resolution of immune haemolytic anaemia with allogeneic bone marrow transplantation after an unsuccessful autograft

Autologous transplantation of lymphocyte-depleted peripheral blood stem cel ls (PBSC) has been proposed for treatment of patients with severe autoimmun e disease. However, several patients have been reported to achieve only tra nsient remissions. We report on a child with thalassaemia intermedia and im mune-mediated haemolytic anaemia, given an autologous lymphocyte-depleted P BSC transplant, who relapsed 7 weeks after transplant. A complete remission , lasting 18 months to date, was obtained with allogeneic bone marrow trans plantation (BMT) from an HLA-matched unrelated donor. This experience indic ates that, in selected cases, allogeneic BMT may be the treatment of choice for life-threatening autoimmune disease. A graft-versus-autoimmunity effec t may favour the eradication of the recipient autoaggressive lymphocytes.