Haem History

Allogeneic Stem Cell Transplant



  • An allogeneic stem cell transplant involves depleting a patient's bone marrow using chemotherapy, and then transfusing another (matched) patient's stem cells. This serves purposes of both replacing their haematopoietic cells with normal cells, and providing some degree of graft-vs-disease effect.
  • Allogeneic stem cell transplants are associated with a high risk of complications and mortality, and require long-term immunosuppression.
    • Ask About

    • Peritransplant history - when the transplant was done, indication, type of transplant, conditioning
    • Complications
    • Post-transplant management

Peritransplant History

    • Ask About

    • When
    • Indication for allogeneic stem cell transplant
    • Type of transplant - syngeneic, matched sibling, MUD, haploidentical, cord blood
    • Donor - HLA match, CMV status
    • Recipient - CMV status
    • Conditioning - myeloablative or reduced intensity (RIC)
    • Indications for Allogeneic Stem Cell Transplant

    • Acute myeloblastic leukaemia
    • Acute lymphoblastic leukaemia
    • Aplastic anaemia
    • Relapsed refractory lymphoma
    • Types of Allogeneic Stem Cell Transplant

    • Syngeneic allograft - identical twin donor with the same major and minor HLA antigens
    • Matched sibling allograft - all major HLA antigens matched; minor antigens more likely to match
    • Matched unrelated donor (MUD) allograft - major HLA antigens matched; minor antigens partially matched
    • Mismatched unrelated donor allograft- some major and minor HLA antigens matched
    • Haploidentical allograft (unmatched sibling, parent, child or other family member) - half of major HLA antigens matched
    • Cord blood allograft


    • Complications of Allogeneic Stem Cell Transplant

    • Infectious

    • Fungal infections - candida, aspergillus, cryptococcus
    • Viral infections - herpes simplex, varicella, CMV, EBV, influenza, BK virus, JC virus
    • Bacterial infections - mycobacterial, pneumococcal
    • Protozoal infections - pneumocystis, toxoplasmosis
    • Non-Infectious

    • Mucositis
    • Bone marrow suppression
    • Graft vs host disease (GVHD) - acute / chronic
    • Post-transplant lymphoproliferative disorder
    • Sinusoidal obstructive syndrome (jaundice, hepatomegaly, fluid retention)
    • Rejection
    • Disease relapse

Post-Transplant Management

    • Management Strategy

    • Transfusion support
    • GVHD prophylaxis - cyclosporine, methotrexate
    • Infective prophylaxis - e.g. bactrim, posaconazole, ganciclovir / valganciclovir
    • Vaccinations
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 Al-Nouri ZL, Reese JA, Terrell DR, Vesely SK, George JN. Drug-induced thrombotic microangiopathy: a systematic review of published reports. Blood. 2014 Jan 1:blood-2014. Arndt PA, Garratty G. The changing spectrum of drug-induced immune hemolytic anemia. InSeminars in hematology 2005 Jul 1 (Vol. 42, No. 3, pp. 137-144). WB Saunders. Aster RH, Bougie DW. Drug-induced immune thrombocytopenia. New England Journal of Medicine. 2007 Aug 9;357(6):580-7. Aster RH, Curtis BR, McFarland JG, Bougie DW. Drug?induced immune thrombocytopenia: pathogenesis, diagnosis, and management. Journal of Thrombosis and Haemostasis. 2009 Jun;7(6):911-8. Beutler E. G6PD deficiency. Blood. 1994 Dec 1;84(11):3613-36. Bhatt V, Saleem A. Drug-induced neutropenia–pathophysiology, clinical features, and management. Annals of Clinical & Laboratory Science. 2004 Apr 1;34(2):131-7. Bing RJ, Lomnicka M. Why do cyclo-oxygenase-2 inhibitors cause cardiovascular events?. Bubp J, Jen M, Matuszewski K. Caring for glucose-6-phosphate dehydrogenase (G6PD)–deficient patients: Implications for pharmacy. Pharmacy and Therapeutics. 2015 Sep;40(9):572. Chan FC, Lau KK, Chan AK, Chan HH. Tranexamic acid is a weak provoking factor for thromboembolic events: A systematic review of the literature. Davis JM, Albert JD, Tracy KJ, Calvano SE, Lowry SF, Shires GT, Yurt RW. Increased neutrophil mobilization and decreased chemotaxis during cortisol and epinephrine infusions. The Journal of trauma. 1991 Jun;31(6):725-31. Dlott JS, Danielson CF, Blue?Hnidy DE, J McCarthy L. Drug?induced thrombotic thrombocytopenic purpura/hemolytic uremic syndrome: a concise review. Therapeutic Apheresis and Dialysis. 2004 Apr;8(2):102-11. Frank JE. Diagnosis and management of G6PD deficiency. American family physician. 2005 Oct;72(7):1277-82. Garbe E, Andersohn F, Bronder E, Salama A, Klimpel A, Thomae M, Schrezenmeier H, Hildebrandt M, Späth-Schwalbe E, Grüneisen A, Meyer O. Drug-induced immune thrombocytopaenia: results from the Berlin Case–Control Surveillance Study. European journal of clinical pharmacology. 2012 May 1;68(5):821-32. Hesdorffer CS, Longo DL. Drug-induced megaloblastic anemia. New England Journal of Medicine. 2015 Oct 22;373(17):1649-58. Kaferle J, Strzoda CE. Evaluation of macrocytosis. American family physician. 2009 Feb 1;79(3). Kast RE. How lithium treatment generates neutrophilia by enhancing phosphorylation of GSK-3, increasing HIF-1 levels and how this path is important during engraftment. Bone marrow transplantation. 2008 Jan;41(1):23.
Kaufman DW, Kelly JP, Jurgelon JM, Anderson T, Issaragrisil S, Wiholm BE, Young NS, Leaverton P, Levy M, Shapiro S. Drugs in the aetiology of agranulocytosis and aplastic anaemia. European Journal of Haematology. 1996 Dec;57(S60):23-30.
 Kim Y, Bang OY. Paradoxical procoagulant effect of early doses of warfarin: possible role of non-vitamin K oral anticoagulant in patients with atrial fibrillation-related stroke. Journal of stroke. 2015 May;17(2):216. Lacy P. Mechanisms of degranulation in neutrophils. Allergy, Asthma & Clinical Immunology. 2006 Sep;2(3):98. Low MS, Vilcassim S, Fedele P, Grigoriadis G. Anabolic androgenic steroids, an easily forgotten cause of polycythaemia and cerebral infarction. Internal medicine journal. 2016 Apr;46(4):497-9. Marsh JC, Ball SE, Cavenagh J, Darbyshire P, Dokal I, Gordon?Smith EC, Keidan J, Laurie A, Martin A, Mercieca J, Killick SB. Guidelines for the diagnosis and management of aplastic anaemia. British journal of haematology. 2009 Oct;147(1):43-70. Means RT. Pure red cell aplasia. Blood. 2016 Jan 1:blood-2016. Mintzer DM, Billet SN, Chmielewski L. Drug-induced hematologic syndromes. Advances in hematology. 2009;2009. Noris M, Remuzzi G. Atypical hemolytic–uremic syndrome. New England Journal of Medicine. 2009 Oct 22;361(17):1676-87.
Patel JN, Jiang C, Hertz DL, Mulkey FA, Owzar K, Halabi S, Ratain MJ, Friedman PN, Small EJ, Carducci MA, Mahoney JF. Bevacizumab and the risk of arterial and venous thromboembolism in patients with metastatic, castration?resistant prostate cancer treated on Cancer and Leukemia Group B (CALGB) 90401 (Alliance). Cancer. 2015 Apr 1;121(7):1025-31.
Pintova S, Bhardwaj AS, Aledort LM. IVIG—a hemolytic culprit. New England Journal of Medicine. 2012 Sep 6;367(10):974-6.
 Ramot Y, Nyska A, Spectre G. Drug-induced thrombosis: an update. Drug safety. 2013 Aug 1;36(8):585-603. Rauscher C, Freeman A. Drug-induced eosinophilia. InAllergy & Asthma Proceedings 2018 May 1 (Vol. 39, No. 3). Reese JA, Li X, Hauben M, Aster RH, Bougie DW, Curtis BR, George JN, Vesely SK. Identifying drugs that cause acute thrombocytopenia: an analysis using three distinct methods. Blood. 2010 Jan 1:blood-2010. Salama A. Drug-induced immune hemolytic anemia. Expert opinion on drug safety. 2009 Jan 1;8(1):73-9. Saste VV, Terrell DR, Vesely SK, George JN. Drug-Associated Thrombotic Thrombocytopenic Purpura-Hemolytic Uremic Syndrome (TTP-HUS): Frequency, Presenting Features, and Clinical Outcomes. Serebruany VL. Selective serotonin reuptake inhibitors and increased bleeding risk: are we missing something?. The American journal of medicine. 2006 Feb 1;119(2):113-6. Soloway HB. Drug-induced bleeding. American journal of clinical pathology. 1974 May 1;61(5):622-7. Stroncek DF. Drug-induced immune neutropenia. Transfusion medicine reviews. 1993 Oct;7(4):268-74. Sundström A, Seaman H, Kieler H, Alfredsson L. The risk of venous thromboembolism associated with the use of tranexamic acid and other drugs used to treat menorrhagia: a case–control study using the General Practice Research Database. BJOG: An International Journal of Obstetrics & Gynaecology. 2009 Jan 1;116(1):91-7. Tenner S, Rollhauser C, Butt F, Gonzalez P. Sideroblastic anemia: A diagnosis to consider in alcoholic patients. Postgraduate medicine. 1992 Nov 15;92(7):147-50. Tesfa D, Keisu M, Palmblad J. Idiosyncratic drug?induced agranulocytosis: possible mechanisms and management. American journal of hematology. 2009 Jul;84(7):428-34. Tobu M, Iqbal O, Fareed D, Chatha M, Hoppensteadt D, Bansal V, Fareed J. Erythropoietin-induced thrombosis as a result of increased inflammation and thrombin activatable fibrinolytic inhibitor. Clinical and applied thrombosis/hemostasis. 2004 Jul;10(3):225-32. Visentin GP, Liu CY. Drug-induced thrombocytopenia. Hematology/oncology clinics of North America. 2007 Aug 1;21(4):685-96.
Wickramasinghe SN. Diagnosis of megaloblastic anaemias. Blood reviews. 2006 Nov 1;20(6):299-318.
Williams C. Drug-induced eosinophilia. Lung cancer. 2018 Jun 12;15:05.
 Yang Y, Li Z, Nan P, Zhang X. Drug-induced glucose-6-phosphate dehydrogenase deficiency-related hemolysis risk assessment. Computational biology and chemistry. 2011 Jun 1;35(3):189-92.