Rituximab Combined with Donor Lymphocyte Infusion Cured Immunohemolysis after Refractory Hematopoietic Stem Cell Transplantation

Background

Immuno-hemolytic anemia is a severe complication after allogeneic hematopoietic stem cell transplantation (HSCT). Primary or secondary reaction between recipient lymphocytes and donor RBC antigens was considered as one of cause of post-transplantation immune-hemolysis (PTI). Different treatments can be administered according to the donor cell chimeric status and antibody titer of blood types of the donor in recipient.

Objective:

To find the ways of treatment of PTI after HSCT.

Methods:

A retrospective analysis about the complications of 707 patients underwent HSCT in our center from January 2010 to July 2017 was made. Of them, PI occurred in 28 patients with positive direct Coomb's test. By donor cell chimerism status, the 28 patients with PTI were divided into two groups. In group 1 (n=11), the patients presented full donor chimerism and received rituximab or/and steroid treatment only; In group 2 (n=17), the patients presented mixed chimerism and received rituximab and gradually decreasing immunosuppressive agents with/without, thereafter, donor lymphocyte infusion (DLI).

Results: A total of 28 patients was cured after treatment. Of 11 cases in group 1, five patients developed grade 1-2 acute GVHD and four of which developed pancytopenia. Of 17 patients with mixed chimerism (75-99.5%) in group 2, four had post-HSCT pure red blood cell aplasia and the major blood type incompatibility between the donor and recipients. In group 2, six patients with PTI were cured by rituximab and gradually decreasing immunosuppressive therapy only; 11 patients had no respond to the treatment of these treatments, and were cured after combined with DLI.

Conclusion:

When PTI occurred, chimerism status may help us to determine how to treat PTI. For patients with full donor cell chimerism, it may be fit to give rituximab and to reduce immunosuppressive agent gradually. DLI may be given to the patients with mixed chimerism and no responding to the combined therapy of rituximab and immunosuppressive agent reduction.