Transient anti rhesus alloantibody produced by graft after non-myeloablative allogeneic stem cell transplant

• Published in: Transfusion and apheresis science Vol. 31; no. 3; pp. 191 - 197
• Main Authors: Contentin, N., Lenain, P., Chamouni, P., Hau, F., Bastit, D., Buchonnet, G., Tilly, H.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.12.2004
• Subjects: Allogeneic peripheral blood stem cell; Alloimmunisation; Carcinoma, Renal Cell - therapy; Erythrocyte Transfusion; Health technology assessment; Humans; Isoantibodies - blood; Kidney Neoplasms - therapy; Male; Middle Aged; Non-myeloablative stem cell transplant; Renal cell carcinoma; Rh-Hr Blood-Group System - immunology; Rhesus blood system; Stem Cell Transplantation; Transplantation, Homologous; Alloimmunisation; Rhesus blood system; Renal cell carcinoma; Non-myeloablative stem cell transplant; Allogeneic peripheral blood stem cell
• ISSN: 1473-0502; 1878-1683
• DOI: 10.1016/j.transci.2004.01.013

Background: We report the case of a patient who received an allogeneic transplant with peripheral blood compatible ABO, Rhesus mismatched progenitor cells and who developed an asymptomatic transient anti Rhesus alloimmunisation. Case report: A 56-year-old man with renal cell carcinoma received a non-myeloablative allogeneic PBPC ABO compatible graft from his HLA-identical brother. Graft-versus-host disease prophylaxis consisted of cyclosporine alone. On day + 59, prior to any transfusion, a positive direct antiglobulin test (IgG++, C3d−) was detected. The indirect antiglobulin test (IAT) was considered doubtful, and IAT identification revealed the presence of an active anti Rhesus antibody (anti D specificity) in the patient’s serum. This immunisation had no clinical consequence, with no acute hemolytic episode. Further monitoring showed negative antibody screening tests on day + 78. Conclusion: To our knowledge this is the first reported case of transient anti Rh (D) allo-immunisation after non-myeloablative allogeneic peripheral blood progenitor cell (PBPC) transplant. The period of occurrence and the specificity of this antibody strongly suggest a donor cell origin.