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Current Oncology Reports

, 21:87 | Cite as

Immune-Mediated Cytopenias After Hematopoietic Cell Transplantation: Pathophysiology, Clinical Manifestations, Diagnosis, and Treatment Strategies

  • Thomas F. MichniackiEmail author
  • Christen L. Ebens
  • Sung Won Choi
Pediatric Oncology (G Tian, Section Editor)
  • 12 Downloads
Part of the following topical collections:
  1. Topical Collection on Pediatric Oncology

Abstract

Purpose of Review

Discuss the pathophysiology, clinical presentation, diagnosis, and treatment of immune-mediated cytopenias (IMC) after hematopoietic cell transplantation (HCT).

Recent Findings

Key risk factors for post-HCT IMC include younger age, non-malignant disease, and umbilical cord blood stem cell source. While anemia predominates, any or all three hematopoietic cell lines can be affected. In rare cases, IMC can cause graft failure or death. IMC is hypothesized to result from immune dysregulation upon reconstitution of donor hematopoietic cells (i.e., dysfunctional regulatory T cells). Aside from blood product transfusions, IMC treatment includes immune-suppressive or ablative agents. First-line therapies, including corticosteroids and intravenous immunoglobulin, are often inadequate, prompting use of additional agents aimed at antibody production/T cell dysfunction or direct antibody removal via plasmapheresis.

Summary

IMC occurs in up to 20% of high-risk HCT populations. Morbidity and mortality from IMC post-HCT have been reduced by improved recognition and aggressive early interventions.

Keywords

Hematopoietic cell transplantation Bone marrow transplantation Immune-mediated cytopenias Anemia Thrombocytopenia Neutropenia 

Notes

Compliance with Ethical Standards

Conflict of Interest

Thomas F. Michniacki, Christen L. Ebens, and Sung Won Choi declare they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Thomas F. Michniacki
    • 1
    Email author
  • Christen L. Ebens
    • 2
  • Sung Won Choi
    • 1
  1. 1.Department of Pediatrics, Division of Pediatric Hematology/Oncology & Bone Marrow TransplantationUniversity of MichiganAnn ArborUSA
  2. 2.Department of Pediatrics, Division of Blood and Marrow TransplantationUniversity of MinnesotaMinneapolisUSA

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