Summary:
The pathogenesis of thrombocytopenia occurring after autologous stem cell transplantation (ASCT) remains unclear. Six cases of classical peripheral thrombocytopenia that developed after ASCT for non-Hodgkin's lymphoma (NHL) are presented. Resolution of this complication was obtained by usual treatment such as steroids, splenectomy or progressively resolved without specific treatment. Five out of six patients have been followed for more than 5 years after hematopoietic transplantation and are still alive in complete remission despite poor prognostic factors at diagnosis. Several arguments suggest that this phenomenon represents autoimmune thrombocytopenia and may be the consequence of an altered immune balance. Consequently, development of autoimmune reactions after bone marrow transplantation might be associated with an antitumoral effect (graft-versus-lymphoma effect).
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Ashihara E, Shimazadi C, Hirata T et al. Autoimmune thrombocytopenia following peripheral blood stem cell autografting. Bone Marrow Transplant 1993; 12: 297–299.
Minchinton RM, Waters AH, Malpas JS et al. Platelet- and granulocyte-specific antibodies after allogeneic and autologous bone marrow grafts. Vox Sang 1984; 46: 125–135.
Ketterer N, Sonet A, Dumontet C et al. Toxicities after peripheral progenitor cell transplantation for lymphoid malignancies: analysis of 300 cases in a single institution. Bone Marrow Transplant 1999; 23: 1309–1315.
Kiefel V, Santoso S, Weisheit M, Mueller-Eckhardt C . Monoclonal antibody-specific immobilization of platelet antigens (MAIPA): a new tool for the identification of platelet-reactive antibodies. Blood 1987; 70: 1722–1726.
Coiffier B, Gisselbrecht C, Vose JM et al. Prognostic factors in aggressive malignant lymphomas : description and validation of a prognostic index that could identify patients requiring a more intensive therapy. The Groupe d'Etude des Lymphomes Agressifs. J Clin Oncol 1991; 9: 211–219.
Moreb JS, Kubilis PS, Mullins DL et al. Increased frequency of autoaggression syndrome associated with autologous stem cell transplantation in breast cancer patients. Bone Marrow Transplant 1997; 19: 101–106.
Jones RJ, Hess AD, Mann RB et al. Induction of graft-versus-host disease after autologous bone marrow transplantation. Lancet 1989; 1: 754–757.
Sivakumaran M, Hutchinson RM, Pringle H et al. Thrombocytopenia following autologous bone marrow transplantation: evidence for autoimmune aetiology and B cell clonal involvement. Bone Marrow Transplant 1995; 15: 531–536.
Ishikawa F, Shigematsu H, Gondo H et al. Autoreactive antibodies following autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 1998; 22: 729–731.
Klumpp TR, Herman JK, McDonald JS et al. Autoimmune neutropenia following peripheral blood stem cell transplantation. Am J Hematol 1992; 41: 215–217.
Odell TT, Murphy JR, Jackson CW . Stimulation of megacaryocytopoiesis by acute thrombocytopenia in rats. Blood 1976; 48: 765–775.
Drobyski WR, Potluri J, Sauer D, Gottschall JL . Autoimmune hemolytic anemia following T-cell-depleted allogeneic bone marrow transplantation. Bone Marrow Transplant 1996; 17: 1093–1099.
Kottaridis PD, Rees H, Smith G et al. A fatal case of autoimmune thrombocytopenia with an IgM anti-GPIb/IX following one mismatched unrelated donor bone marrow transplantation. Bone Marrow Transplant 1999; 23: 739–741.
Dourakis SP, Deutsch M, Hadziyannis SJ . Immune thrombocytopenia and alpha-interferon therapy. J Hepatol 1996; 25: 972–975.
Semple JW, Freedman J . Abnormal cellular immune mechanisms associated with autoimmune thrombocytopenia. Transfus Med Rev 1995; 9: 327–338.
Mylvaganam R, Ahn YS, Sprinz PG et al. Sex differences in the CD4CD45R+ T lymphocytes in normal individuals and its selective decrease in women with idiopathic thrombocytopenic purpura. Clin Immunol Immunopathol 1989; 52: 473–485.
Sadat-Sowti B, Debre P, Mollet L et al. An inhibitor of cytotoxic functions produced by CD8+CD57+ T lymphocytes from patients suffering from AIDS and immunosuppressed bone marrow recipients. Eur J Immunol 1994; 24: 2882–2888.
Jonuleit H, Schmidt E, Stassen M et al. Identification and functional characterization of human CD4+CD25+ T-cells regulatory properties isolated from peripheral blood. J Exp Med 2001; 11: 1285–1294.
Roberts MM, To LB, Gillis D et al. Immune reconstitution following peripheral blood stem cell transplantation, autologous bone marrow transplantation and allogeneic bone marrow transplantation. Bone Marrow Transplant 1993; 12: 469–475.
Singh RK, Varney ML, Kazuhiko I et al. Immune dysfunction despite high levels of immunoregulatory cytokine gene expression in autologous peripheral blood stem cell transplanted non-Hodgkin's lymphoma patients. Exp Hematol 2000; 28: 499–507.
Jillella AP, Kallab AM, Kutlar A . Autoimmune thrombocytopenia following autologous hematopoietic cell transplantation: review of literature and treatment options. Bone Marrow Transplant 2000; 26: 925–927.
DiRaimono F, Giustolisi R, Cacciola E et al. Autoimmune hemolytic anemia in chronic lymphocytic leukemia patients treated with Fludarabine. Leukaemia Lymphoma 1993; 11: 63–69.
Itoh M, Takahashi T, Sakaguchi N et al. Thymus and autoimmunity: production of CD4+CD25+ naturally anergic and suppressive T cells as a key function of the thymus in maintaining immunologic self-tolerance. J Immunol 1999; 162: 5317–5326.
Malphettes M, Carcelain G, Saint-Mezard P et al. Evidence for naïve T-cell repopulation despite thymus irradiation after autologous transplantation in adults with multiple myeloma: role of ex-vivo CD34+ selection and age. Blood 2002; 101: 1891–1897.
Fischer AC, Beschorner WE, Hess AD . Requirements for the induction and adoptive transfer of cyclosporin-induced syngeneic graft-versus-host disease. J Exp Med 1989; 169: 1031–1041.
Lambbertenghi Deliliers G, Annaloro C, Della Volpe A et al. Multiple autoimmune events after autologous bone marrow transplantation. Bone Marrow Transplant 1997; 19: 745–747.
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Hequet, O., Salles, G., Ketterer, N. et al. Autoimmune thrombocytopenic purpura after autologous stem cell transplantation. Bone Marrow Transplant 32, 89–95 (2003). https://doi.org/10.1038/sj.bmt.1704073
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DOI: https://doi.org/10.1038/sj.bmt.1704073
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