Relapse of aplastic anemia with majority donor chimerism (donor-type aplasia) occurring late after bone marrow transplantation

Shaw, A.; Passweg, J.R.; Fuente, J. de la; Bajwa, R.; Stein, J.; Al-Zaben, A.; Halkes, C.J.M.; Norton, A.; Cummins, M.; Moppett, J.P.; Abu Shanap, M.; Steward, C.G.; European Soc Blood Marrow Transpla

doi:doi:10.1016/j.bbmt.2019.11.010

Persistent URL of this record https://hdl.handle.net/1887/3185055

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Medicine / Leiden University Medical Centre (LUMC)

Shaw, A.; Passweg, J.R.; Fuente, J. de la; Bajwa, R.; Stein, J.; Al-Zaben, A.; ... ; European Soc Blood Marrow Transpla (2020)

Relapse of aplastic anemia with majority donor chimerism (donor-type aplasia) occurring late after bone marrow transplantation

Article / Letter to editor

There have been sporadic reports of the development of delayed disease recurrence after bone marrow transplantation for severe aplastic anemia despite sustained majority or full donor chimerism. This is termed "donor-type aplasia" (DTA). We describe the management and outcome of 11 pediatric patients from 8 institutions in Europe, the United States, and the Middle East who developed DTA at a mean of 35 months post-transplant. These patients were initially transplanted at a mean age of 10.0 years (range, 5.8 to 16.0 years), 9 from matched sibling donors and 2 from matched unrelated donors. Attempts to treat DTA with varying combinations of additional immunosuppression (including intravenous immunoglobulin, donor lymphocyte infusions, stem cell boosts, and other therapies) failed. Ten patients have received a conditioned second transplant, 9 from the same donor and 1 from a new matched unrelated donor. Aplasia has resolved in the remaining patient in response to ongoing eltrombopag...Show moreThere have been sporadic reports of the development of delayed disease recurrence after bone marrow transplantation for severe aplastic anemia despite sustained majority or full donor chimerism. This is termed "donor-type aplasia" (DTA). We describe the management and outcome of 11 pediatric patients from 8 institutions in Europe, the United States, and the Middle East who developed DTA at a mean of 35 months post-transplant. These patients were initially transplanted at a mean age of 10.0 years (range, 5.8 to 16.0 years), 9 from matched sibling donors and 2 from matched unrelated donors. Attempts to treat DTA with varying combinations of additional immunosuppression (including intravenous immunoglobulin, donor lymphocyte infusions, stem cell boosts, and other therapies) failed. Ten patients have received a conditioned second transplant, 9 from the same donor and 1 from a new matched unrelated donor. Aplasia has resolved in the remaining patient in response to ongoing eltrombopag therapy. All patients were alive at a mean of 92 months (range, 26 to 195) after a second transplant; 6 are in complete remission, but 4 suffered from second/recurrent DTA at 16 to 129 months after retransplant and required further transplant therapy. (C) 2019 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.Show less

Aplastic anemia

Donor-type aplasia

Hematopoietic stem cell transplantation

Chimerism testing