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Autoimmune Cytopenias (AIC) Following Allogeneic Haematopoietic Stem Cell Transplant for Acquired Aplastic Anaemia: a Joint Study of the Autoimmune Diseases and Severe Aplastic Anaemia Working Parties (ADWP/SAAWP) of the European Society for Blood and Marrow Transplantation (EBMT)

Paul D. E. MillerJohn A. SnowdenRegis Peffault De LatourSimona IacobelliDiderik-Jan EikemaCora KnolJudith C. W. MarshCarmel RiceMickey KohFranca FagioliSridhar ChagantiJürgen FinkeRafael F. DuartePeter BaderDominique FargeJakob R. PasswegJ. Alejandro MadrigalCarlo Dufour

出版	Universität, 2020
URL	http://books.google.com.hk/books?id=WZqczQEACAAJ&hl=&source=gbs_api

註釋

Abstract: This retrospective study explored the incidence of autoimmune cytopenia (AIC) in 530 paediatric and adult patients with
acquired aplastic anaemia (aAA) who underwent first allogeneic HSCT between 2002 and 2012. AIC was a rare
complication with a cumulative incidence of AIC at 1, 3, 5 and 10 years post HSCT of 2.5% (1.2-3.9 95% CI), 4.4%
(2.6-6.2 95% CI), 4.6% (2.8-6.5 95% CI) and 5.1% (3.1-7.2 95% CI). Overall survival at 5 years after diagnosis of AIC was
85.9% (71-100 95% CI). Twenty-five patients were diagnosed with AIC at a median of 10.6 (2.6-91.5) months post HSCT.
Eight (32%) patients were diagnosed with immune thrombocytopenia (ITP), seven (28%) with autoimmune haemolytic
anaemia (AIHA), seven (24%) with Evans syndrome and four (16%) with autoimmune neutropenia (AIN). Treatment
strategies were heterogeneous. Complete responses were seen in 12 of 25 patients, with death in three patients. In
multivariable Cox analysis of a subgroup of 475 patients, peripheral blood stem cell (PBSC) transplant was associated with
higher risk of AIC compared with bone marrow (BM) when conditioning regimens contained fludarabine and/or
alemtuzumab (2.81 [1.06-7.49 95% CI]; p = 0.038), or anti-thymocyte globulin (ATG) (2.86 [1.11-7.37 95% CI]; p =
0.029). Myeloablative conditioning was associated with a lower risk of AIC compared with reduced intensity conditioning
(RIC) in fludarabine and/or alemtuzumab (0.34 [0.12-0.98 95% CI]; p = 0.046) and ATG containing regimens (0.34
[0.12-0.95 95% CI]; p = 0.04). These findings provide clinically useful information regarding the incidence of a rare and
potentially life-threatening complication of allogeneic HSCT for aAA, and further support for BM as the preferred stem cell
source for transplant of patients with aAA