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PLASTIC RECONSTRUCTIVE AND REGENERATIVE SURGERY

Case report

Vol. 22 No. 6 (2024): Blood Transfusion 6-2024 (November-December)

Recurrent disease after a matched sibling hematopoietic transplant in an aplastic anemia patient with a disease risk allele, HLA-B*40:02

Authors

Akshita Khosla , Yoshitaka Inoue , Joseph Cioccio , Kevin Rakszawski , Natthapol Songdej , Myles Nickolich , Hong Zheng , Seema Naik , Christopher Ehmann , David Claxton , Witold Rybka , Jeffrey Sivik , Joseph Mierski , Brooke Silar , Caitlin Vajdic , Raymond Hohl , Hiroko Shike , Shin Mineishi , Kentaro Minagawa

Key words: Hematologic Diseases, Bone Marrow Diseases, Bone Marrow Failure Disorders, Hematopoietic Stem Cell Transplantation
Doi: 10.2450/BloodTransfus.674
Hematopoietic stem cell transplantation and cord blood banking
Publication Date: 2024-08-26

Abstract

A 20-year-old female with HLA-B*40:02, considered to be one of the most studied aplastic anemia (AA) risk HLA allele, was diagnosed with severe AA. She received allogeneic hematopoietic cell transplantation (HSCT) from an HLA-matched sibling donor. Although she achieved engraftment on Day +13, blood counts started to decrease from Day +100 prior to donor chimerism decline, and she developed severe pancytopenia by Day +157 after 1st HSCT. We considered this is a disease recurrence due to cytotoxic T lymphocytes attacking hematopoietic stem cells mediated by HLA-B*40:02. She received 2nd HSCT from a haploidentical donor without HLA-B*40:02. She achieved engraftment on Day +13 and complete donor chimerism after 2nd HSCT. Our experience suggested that performing a second allogeneic transplant without AA risk allele may be beneficial after a failed HSCT.

References

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Authors

Akshita Khosla Blood and Marrow Transplant Program, Division of Hematology and Oncology, Penn State Cancer Institute, Hershey, PA, Unites States of America

Yoshitaka Inoue Blood and Marrow Transplant Program, Division of Hematology and Oncology, Penn State Cancer Institute, Hershey, PA, Unites States of America; Penn State College of Medicine, Hershey, PA, Unites States of America; Department of Hematology, Kumamoto University, Kumamoto, Japan

Joseph Cioccio Blood and Marrow Transplant Program, Division of Hematology and Oncology, Penn State Cancer Institute, Hershey, PA, Unites States of America

Kevin Rakszawski Blood and Marrow Transplant Program, Division of Hematology and Oncology, Penn State Cancer Institute, Hershey, PA, Unites States of America

Natthapol Songdej Blood and Marrow Transplant Program, Division of Hematology and Oncology, Penn State Cancer Institute, Hershey, PA, Unites States of America

Myles Nickolich Blood and Marrow Transplant Program, Division of Hematology and Oncology, Penn State Cancer Institute, Hershey, PA, Unites States of America

Hong Zheng Blood and Marrow Transplant Program, Division of Hematology and Oncology, Penn State Cancer Institute, Hershey, PA, Unites States of America

Seema Naik Blood and Marrow Transplant Program, Division of Hematology and Oncology, Penn State Cancer Institute, Hershey, PA, Unites States of America

Christopher Ehmann Blood and Marrow Transplant Program, Division of Hematology and Oncology, Penn State Cancer Institute, Hershey, PA, Unites States of America

David Claxton Blood and Marrow Transplant Program, Division of Hematology and Oncology, Penn State Cancer Institute, Hershey, PA, Unites States of America

Witold Rybka Blood and Marrow Transplant Program, Division of Hematology and Oncology, Penn State Cancer Institute, Hershey, PA, Unites States of America

Jeffrey Sivik Pharmacy, Penn State Cancer Institute, Hershey, PA, Unites States of America

Joseph Mierski Blood and Marrow Transplant Program, Division of Hematology and Oncology, Penn State Cancer Institute, Hershey, PA, Unites States of America

Brooke Silar Blood and Marrow Transplant Program, Division of Hematology and Oncology, Penn State Cancer Institute, Hershey, PA, Unites States of America

Caitlin Vajdic Blood and Marrow Transplant Program, Division of Hematology and Oncology, Penn State Cancer Institute, Hershey, PA, Unites States of America

Raymond Hohl Blood and Marrow Transplant Program, Division of Hematology and Oncology, Penn State Cancer Institute, Hershey, PA, Unites States of America

Hiroko Shike Pathology, Penn State Cancer Institute, Hershey, PA, Unites States of America

Shin Mineishi Blood and Marrow Transplant Program, Division of Hematology and Oncology, Penn State Cancer Institute, Hershey, PA, Unites States of America

Kentaro Minagawa Blood and Marrow Transplant Program, Division of Hematology and Oncology, Penn State Cancer Institute, Hershey, PA, Unites States of America

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