Successful treatment of severe immune hemolytic anemia after allogeneic stem cell transplantation with bortezomib: report of a case and review of literature

Transfusion. 2015 Feb;55(2):259-64. doi: 10.1111/trf.12815. Epub 2014 Aug 25.


Background: Immune hemolytic anemia is a well-known complication after allogeneic hematopoietic stem cell transplantation (HSCT). Posttransplant hemolytic anemia results in increased red blood cell transfusions and medical sequelae including iron overload.

Case report: We present a case report of immune hemolytic anemia that occurred after allogeneic HSCT from an ABO major-mismatched, HLA-matched unrelated donor. The patient had high anti-donor A type antibodies that were unresponsive to treatment with steroids and rituximab, resulting in persistent transfusion dependence. A detailed time course of anti-A titers, plasma cell content of the marrow, and B-cell content of the blood is presented. Treatment with bortezomib, a protease inhibitor, eliminated residual host-type plasma cells secreting anti-A and restored normal donor-derived erythropoiesis.

Conclusion: This report, and a review of literature for treatment of immune hemolytic anemia after allogeneic HSCT, supports the utility of bortezomib as plasma cell-targeted therapy in this setting.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Allografts
  • Anemia, Hemolytic, Autoimmune / blood
  • Anemia, Hemolytic, Autoimmune / therapy*
  • Antineoplastic Agents / administration & dosage*
  • Boronic Acids / administration & dosage*
  • Bortezomib
  • Erythropoiesis
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Lymphocyte Count
  • Male
  • Middle Aged
  • Plasma Cells / metabolism
  • Plasma Cells / pathology
  • Pyrazines / administration & dosage*
  • Recovery of Function


  • Antineoplastic Agents
  • Boronic Acids
  • Pyrazines
  • Bortezomib