Reversing Red Cell Aplasia After Allogeneic Stem Cell Transplantation

Mismatched ABO blood group allogeneic stem cell transplantation may be complicated by delayed red cell recovery or red cell aplasia, more commonly in the setting of nonmyeloablative conditioning regimens.

In a case report, investigators administered the anti-CD38 monoclonal antibody daratumumab in a blood group O patient requiring weekly transfusion for red cell aplasia following engraftment from a blood group A donor. The patient previously had no response to multiple interventions, including a decreased immunosuppressive regimen and administration of erythropoietin, corticosteroids, and rituximab. The patient received daratumumab weekly for 6 weeks beginning on day 390 following allotransplant, with the intent of targeting the CD38-positive plasma cell population and decreasing anti-A antibody production to permit recovery of donor red cell precursors.

The patient responded after the first dose of daratumumab and became transfusion independent after the second dose. Once the hemoglobin normalized, therapeutic phlebotomy was initiated to resolve transfusion-associated iron overload. The patient's blood type converted to A positive, and hemoglobin remained normal at day 700.