Progress of autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation in children / 国际儿科学杂志

ABSTRACT

In pediatric patients undergoing allogeneic hematopoietic stem cell transplantation(allo-HSCT), the incidence of autoimmune hemolytic anemia(AIHA)ranges from 2% to 6%.Risk factors include younger age at transplantation, non-malignant diseases, unrelated donor transplant, use of lymphocyte-depleting agents, and chronic graft-versus-host disease.These risk factors share the common characteristic of incomplete immune reconstitution or immune dysregulation post-HSCT, which may be related to the pathogenesis of AIHA.The treatment of post-transplant AIHA is challenging, with no standardized treatment guidelines currently available.Steroids remain the first-line treatment, but the relapse rate is high, with a complete remission rate of approximately 30%.Other conventional treatments such as intravenous immunoglobulin, plasma exchange, and splenectomy are usually ineffective for post-transplant AIHA.In recent years, some studies have explored second or third-line treatment options using monoclonal antibodies and immunosuppressive agents, with higher remission rates.However, the limited availability of studies makes sustained remission uncertain.This article reviews the progress in risk factors, pathogenesis, diagnosis and therapeutic options for post-transplant AIHA, providing improved strategies for the treatment of refractory/recurrent AIHA.