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Sustained engraftment post bone marrow transplant despite anti‐platelet antibodies in Glanzmann thrombasthenia
Author(s) -
Flood Veronica H.,
Johnson F. Leonard,
Boshkov Lynn K.,
Thomas Gregory A.,
Nugent Diane J.,
Bakke Antony C.,
Nicholson H. Stacy,
Tilford David,
Brown Mary P.,
Godder Kamar T.
Publication year - 2005
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.20365
Subject(s) - medicine , platelet , thrombasthenia , busulfan , cyclophosphamide , platelet transfusion , glanzmann's thrombasthenia , bone marrow , abo blood group system , platelet disorder , antibody , gastroenterology , immunology , surgery , chemotherapy , platelet aggregation
Background Patients with Glanzmann thrombasthenia (GT) have normal platelet counts but abnormal platelet aggregation and carry the risk of life‐threatening bleeding. We report three patients who received bone marrow transplantation (BMT) for type I GT and discuss the risk and management of anti‐platelet antibodies. Patients and Results Diagnosis of GT was made through abnormal platelet aggregation studies or the absence of GPIIb/IIIa by flow cytometry. All patients had severe bleeding requiring multiple red blood cell transfusions. One patient received an unrelated donor transplant and two received matched sibling donor transplants following conditioning therapy with busulfan, cyclophosphamide, and fludarabine. Two patients developed an anti‐platelet antibody, treated in one with intravenous immune globulin (IVIG). Engraftment of white blood cells and platelets was achieved on day +13 to +14 and +17 to +25, respectively. Complete donor chimerism and GPIIb/IIIa+ platelets are sustained at +22 to +30 months post transplant. Conclusions In summary, patients with GT and history of severe hemorrhage can be cured with BMT, but the presence of anti‐platelet antibodies should be sought and platelet transfusions minimized prior to transplant. IVIG may be helpful in cases of refractory immune thrombocytopenia related to anti‐platelet antibodies. Improvement in transplant‐related complications with current transplant regimens allows consideration of BMT for life‐threatening non‐malignant disorders such as GT. Pediatr Blood Cancer © 2005 Wiley‐Liss, Inc.