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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.

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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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