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Immune-mediated cytopenias (IMCs) following allogeneic hematopoietic stem cell transplantation (HSCT) can lead to substantial morbidity and mortality, presenting a major therapeutic obstacle. Here, we report a case of a pediatric patient with acquired aplastic anemia. Nine months after HSCT, this patient developed severe, refractory hemolytic anemia and immune-mediated thrombocytopenia (IMT). Despite treatment with corticosteroids, intravenous immunoglobulin (IVIG), rituximab, along with avatrombopag, romiplostim, acetylcysteine, and decitabine, the patient’s platelet count showed no signs of improvement. Subsequently, daratumumab, a monoclonal antibody targeting CD38, was administered. This treatment induced a rapid and sustained response. Four months after initial daratumumab administration, the percentage of CD38-positive immune cells in the patient’s peripheral blood increased, which was concurrent with another decline in platelet levels. After re-initiating daratumumab therapy, the patient’s platelet count returned to normal levels. The only significant adverse effect noted was a delayed recovery of humoral immunity. Daratumumab, by targeting antibody-producing plasma cells, shows promise as a therapeutic alternative for refractory IMCs in post-HSCT patients.
Details
Plasma;
Transplants & implants;
Morbidity;
Cytopenia;
Antibodies;
Graft versus host disease;
Hemolytic anemia;
Cytotoxicity;
Humoral immunity;
Monoclonal antibodies;
Intravenous administration;
Blood platelets;
Disease prevention;
Blood;
Pediatrics;
CD38 antigen;
Corticosteroids;
Hematopoietic stem cells;
Patients;
Case reports;
Aplastic anemia;
Anemia;
Hemoglobin;
Literature reviews;
Immunoglobulins;
Plasma cells;
Acetylcysteine;
Stem cell transplantation;
5-aza-2'-deoxycytidine;
Lymphocytes;
Epistaxis;
Platelets;
Bone marrow;
Thrombocytopenia;
Peripheral blood;
Neutropenia;
Rituximab;
Multiple myeloma;
Pathophysiology
1 Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects, Sichuan University, Ministry of Education, Chengdu, China
2 Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China, West China School of Clinical Medicine, Sichuan University, Chengdu, China
3 Department of Laboratory Medicine, West China Second University Hospital, Chengdu, China
4 Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
5 Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China, West China School of Pharmacy, Sichuan University, Chengdu, China
6 Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China, NHC(National Health Commission) Key Laboratory of Chronobiology, Sichuan University, Chengdu, China