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The role of daratumumab in complications post-allogeneic hematopoietic stem cell transplantation: a single-center prospective study on PRCA and AIHA

Bone Marrow Transplantation volume 60, pages 305–309 (2025)Cite this article

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Abstract

Pure red cell aplasia (PRCA) and autoimmune hemolytic anemia (AIHA) post-hematopoietic stem cell transplantation (HSCT) are an unmet medical need with no established standard of care, significantly affecting the patient quality of life and posing a challenge for clinicians. The anti-CD38 IgG-kappa Daratumumab appears to be a safe and efficace treatment compared to prior drugs. Our study is a prospective monocentric investigation assessing the use of daratumumab in these complications following allo-HSCT. Here we describe our experience on six patients with a median age of 65 years. All treated patients, except one, who died because of sepsis during GVHD exacerbation, reached transfusion independence with erythropoietin suspension. Poor graft function remains a management challenge for clinicians and has a significant impact on the patient’s quality of life. Currently, therapeutic options for PRCA and for the least common AIHA, appear ineffective, making it difficult to address the diverse needs of post-transplant patients. Although our data and those previously reported in the literature are preliminary, daratumumab prompts further reflection on its use in this setting of patients.

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References

  1. Marco-Ayala J, Gómez-Seguí I, Sanz G, Solves P. Pure red cell aplasia after major or bidirectional ABO-incompatible hematopoietic stem cell transplantation: to treat or not to treat, that is the question. Bone Marrow Transpl. 2021;56:769–78.

    Article  Google Scholar 

  2. Bolan CD, Leitman SF, Griffith LM, Wesley RA, Procter JL, Stroncek DF, et al. Delayed donor red cell chimerism and pure red cell aplasia following major ABO-incompatible nonmyeloablative hematopoietic stem cell transplantation. Blood. 2001;98:1687–94.

    Article  PubMed  CAS  Google Scholar 

  3. González-Vicent M, Sanz J, Fuster JL, Cid J, de Heredia CD, Morillo D, et al. Autoimmune hemolytic anemia (AIHA) following allogeneic hematopoietic stem cell transplantation (HSCT): A retrospective analysis and a proposal of treatment on behalf of the Grupo Español De Trasplante de Medula Osea en Niños (GETMON) and the Grupo Español de Trasplante Hematopoyetico (GETH). Transfus Med Rev. 2018;32:179–85.

    Article  Google Scholar 

  4. Salas MQ, Alahmari A, Lipton JH. Successful treatment of refractory red cell aplasia after allogeneic hematopoietic cell transplantation with daratumumab. Eur J Haematol 2020;104:145–7.

    Article  PubMed  CAS  Google Scholar 

  5. DeZern AE, Franklin C, Tsai HL, Hollingsworth Imus P, Cooke KR, Varadhan R, et al. Relationship of donor age and relationship to outcomes of haploidentical transplantation with posttransplant cyclophosphamide. Blood Adv. 2021;5:1360–8.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. Zhu P, Wu Y, Cui D, Shi J, Yu J, Zhao Y, et al. Prevalence of pure red cell aplasia following major ABO-incompatible hematopoietic stem cell transplantation. Front Immunol. 2022;13:829670.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. Means RT Jr. Pure red cell aplasia: the second hundred years. Am J Med Sci. 2023;366:160–6.

    Article  PubMed  Google Scholar 

  8. Ozkurt ZN, Yegin ZA, Yenicesu I, Aki SZ, Yagci M, Sucak GT. Impact of ABO-incompatible donor on early and late outcome of hematopoietic stem cell transplantation. Transpl Proc. 2009;41:3851–8.

    Article  CAS  Google Scholar 

  9. Tekgündüz SA, Özbek N. ABO blood group mismatched hematopoietic stem cell transplantation. Transfus Apher Sci. 2016;54:24–9.

    Article  PubMed  Google Scholar 

  10. Pang Y, Kalsi SS, Childs R, Arai S. Post-hematopoietic stem cell transplantation immune-mediated anemia: a literature review and novel therapeutics. Blood Adv. 2022;6:2707–21.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Watz E, Remberger M, Ringden O, Lundahl J, Ljungman P, Mattsson J, et al. Analysis of donor and recipient ABO incompatibility and antibody-associated complications after allogeneic stem cell transplantation with reduced-intensity conditioning. Biol Blood Marrow Transpl. 2014;20:264–71.

    Article  Google Scholar 

  12. Liu M, Zhang T, Dong X, Wang H. Acquired pure red cell aplasia: unraveling the immune pathogenesis. J Bio-X Res. 2023;6:138–48.

    Google Scholar 

  13. Migdady Y, Pang Y, Kalsi SS, Childs R, Arai S. Post-hematopoietic stem cell transplantation immune-mediated anemia: a literature review and novel therapeutics. Blood Adv. 2022;6:2707–21.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  14. Zhang L, Chen N, Xu Z, Liang Q, Pan H, Zhao J, et al. Good treatment-free survival of monoclonal gammopathy of undetermined significance associated pure red cell aplasia after bortezomib plus dexamethasone. Blood Cells Mol Dis. 2021;89:102573.

    Article  PubMed  CAS  Google Scholar 

  15. Sackett K, Cohn CS, Fahey-Ahrndt K, Smith AR, Johnson AD. Successful treatment of pure red cell aplasia because of ABO major mismatched stem cell transplant. J Clin Apher. 2018;33:108–12.

    Article  PubMed  Google Scholar 

  16. Jeyaraman P, Borah P, Rajput P, Dayal N, Pathak S, Naithani R. Daratumumab for pure red cell aplasia post ABO incompatible allogeneic hematopoietic stem cell transplant for aplastic anemia. Blood Cells Mol Dis. 2021;88:102464.

    Article  PubMed  CAS  Google Scholar 

  17. Chang TY, Jaing TH, Wen YC, Huang IA, Chen SH, Tsay PK. Risk factor analysis of autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation in children. Med (Baltim). 2016;95:e5396.

    Article  Google Scholar 

  18. Li Z, Rubinstein SM, Thota R, Savani M, Brissot E, Shaw BE, et al. Immune-mediated complications after hematopoietic stem cell transplantation. Biol Blood Marrow Transpl. 2016;22:1368–75.

    Article  CAS  Google Scholar 

  19. Gabelli M, Ademokun C, Cooper N, Amrolia PI. Pathogenesis, risk factors and therapeutic options for autoimmune haemolytic anaemia in the post-transplant setting. Br J Haematol. 2022;196:45–62.

    Article  PubMed  CAS  Google Scholar 

  20. Robillard N, Wuillème S, Moreau P, Béné MC. Immunophenotype of normal and myelomatous plasma-cell subsets. Front Immunol. 2014;5:137.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Martino R, García-Cadenas I, Esquirol A. Daratumumab may be the most effective treatment for post-engraftment pure red cell aplasia due to persistent anti-donor isohemagglutinins after major ABO-mismatched allogeneic transplantation. Bone Marrow Transpl. 2022;57:282–5.

    Article  CAS  Google Scholar 

  22. Chapuy CI, Kaufman RM, Alyea EP, Connors JM. Daratumumab for delayed red-cell engraftment after allogeneic transplantation. N. Engl J Med. 2018;379:1846–50.

    Article  PubMed  CAS  Google Scholar 

  23. Gangat N, Bleeker J, Lynch D, Olteanu H, Letendre L, Tefferi A. Daratumumab for treatment-refractory acquired idiopathic pure red cell aplasia. Haematologica. 2022;107:2523–6.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Weverling FG, Roeven MWH, Nijssen KK, Broers AEC, Dovern E, Van Rhenen A, et al. Efficacy and safety of daratumumab in pure red cell aplasia after allogeneic transplantation: Dutch real-world data. Blood Adv. 2024;8:1683–6.

  25. Schuetz C, Hoenig M, Moshous D, Weinstock C, Castelle M, Bendavid M, et al. Daratumumab in life-threatening autoimmune hemolytic anemia following hematopoietic stem cell transplantation. Blood Adv. 2018;2:2550.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  26. Yang EH, Muhsen IN, Samarkandi H, El Fakih R, Aljurf M, Hanbali A. Role of anti-CD38 monoclonal antibodies in the treatment of adult immune hematological diseases. Hematol Oncol Stem Cell Ther. 2023;17:4–12.

    Article  PubMed  Google Scholar 

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Acknowledgements

A thank to JANSSEN for providing drugs for the treatment of these patients as compassionate use.

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Author notes

  1. These authors contributed equally: S. Giammarco, M. A. Limongiello, Patrizia Chiusolo, Simona Sica.

Authors and Affiliations

  1. Dipartimento di Scienze di Laboratorio ed Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    S. Giammarco, M. A. Limongiello & Elisabetta Metafuni

  2. Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy

    Luca Di Marino, Luciana Teofili, Patrizia Chiusolo & Simona Sica

Authors
  1. S. Giammarco
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  2. M. A. Limongiello
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  3. Luca Di Marino
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  4. Elisabetta Metafuni
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  7. Simona Sica
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Contributions

SG, MAL and LDM collected and revised data and wrote the paper, EM was involved in the management of patients, LT is responsible of the cell manipulation center, SS and PC revised the manuscript

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Correspondence to Simona Sica.

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The authors declare no competing interests.

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Giammarco, S., Limongiello, M.A., Di Marino, L. et al. The role of daratumumab in complications post-allogeneic hematopoietic stem cell transplantation: a single-center prospective study on PRCA and AIHA. Bone Marrow Transplant 60, 305–309 (2025). https://doi.org/10.1038/s41409-024-02479-w

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