Premium
Hemolytic anemia due to passenger lymphocyte syndrome in solid malignancy patients treated with allogeneic natural killer cell products
Author(s) -
Skeate Robert,
Singh Charanjeet,
Cooley Sarah,
Geller Melissa,
Northouse Joan,
Welbig Julie,
Slungaard Arne,
Miller Jeff,
McKenna David
Publication year - 2013
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/j.1537-2995.2012.03942.x
Subject(s) - medicine , titer , anemia , typing , immunology , lymphocyte , antibody , hemolytic anemia , peripheral blood mononuclear cell , gastroenterology , biology , microbiology and biotechnology , biochemistry , in vitro
Background Allogeneic natural killer ( NK ) cell products for treatment of solid organ malignancies were prepared by performing T ( CD 3+)‐cell depletion on nonmobilized apheresis mononuclear cell collections. The products were not B ‐cell depleted. This report details two cases of passenger lymphocyte syndrome ( PLS ) after NK ‐cell infusion. Case Reports Patient 1 is a blood group A + 56‐year‐old female with S tage IV ovarian carcinoma who received NK cells from an O + donor. On D ay +7 she developed new hemolytic anemia. Direct antiglobulin test ( DAT ) was positive for immunoglobulin G and C 3, and the eluate contained anti‐ A . Subsequently, anti‐ A was identified on reverse typing. She was transfused with group O red blood cells (RBCs). By D ay +12 she forward typed as O with anti‐ A and B on reverse typing. By D ay +42, DAT was negative with only weak anti‐ A on reverse typing. Patient 2 is a blood group B + 51‐year‐old female with metastatic lobular breast carcinoma who received NK cells from an O + donor. On D ay +7 she developed new hemolytic anemia. DAT was positive, and the eluate contained anti‐ A and ‐ B . Anti‐ A reactivity was due to anti‐ A , B . The next day she developed new anti‐ B on reverse typing. She was transfused with O RBCs. Anti‐ B titer increased to a maximum of 512 on D ay +12. At discharge on D ay +29 her anti‐ B titer was still 32. Conclusions These patients developed PLS after infusion of NK cells. Because of these cases NK ‐cell products are now B ( CD 19+)‐cell depleted at our institution, and this approach is recommended for other centers.