EBMT 2020 | Autoimmune cytopenias following allo-HSCT

This is another important study that has been carried out by the Severe Aplastic Anemia Working Party of EBMT. The PI of the study was Paul Miller and the co-PI was John Snowden. And, actually, it was a very large and important study because it showed that after the transplant, a number of variable cytopenia can occur and they are determined by immune movements, which attack the cells that have been transplanted. Sometimes it’s a kind of autoimmune, so still the lymphocytes of the donor’s attack the hematopoietic stem cells of the donor himself or herself. But we didn’t go into much depth in this respect because, I mean, it was the first study addressing this point, so we could not be more precise.

What is relevant is that the figure accounts between 5 to 10% of cases. So if you add a cytopenia after the bone marrow transplant, either monolineage, bilineage, or trilineage… But trilineage is very rare. Monolineage is more frequent, being a thrombocytopenia the most frequent one. Well, if you have one of these cytopenia, you have also to consider potentially that this is an immune-mediated phenomenon directed towards the cells of the donor and not maybe a relapse in case of marrow failure.