Refractory Evans Syndrome after Autologous Stem Cell Transplantation for Multiple Myeloma: Management with a Second Transplantation

Dai Chihara; Takashi Sakamoto; Kazue Arimoto-Miyamoto; Wataru Kishimoto; Tomoharu Takeoka; Masaaki Tsuji; Tatsuharu Ohno

doi:10.2169/internalmedicine.49.2922

CASE REPORTS

Refractory Evans Syndrome after Autologous Stem Cell Transplantation for Multiple Myeloma: Management with a Second Transplantation

Dai Chihara, Takashi Sakamoto, Kazue Arimoto-Miyamoto, Wataru Kishimoto, Tomoharu Takeoka, Masaaki Tsuji, Tatsuharu Ohno

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Keywords: multiple myeloma, Evans syndrome, autologous stem cell transplantation

JOURNAL OPEN ACCESS

2010 Volume 49 Issue 7 Pages 683-687

DOI https://doi.org/10.2169/internalmedicine.49.2922

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Abstract

The development of autoimmune disease after autologous stem cell transplantation (ASCT) is very rare in multiple myeloma (MM). We describe the first case of Evans syndrome after ASCT for MM. A 60-year-old man with MM received ASCT and subsequently developed Evans syndrome following two febrile episodes. The syndrome was refractory to conventional therapies but it was managed with a second ASCT. This unique complication was thought to have been triggered by an infection during the recovery of the immune system. We assumed that reconstructing the immune system via ASCT might eliminate infection-induced autoantibodies to platelets and erythrocytes.

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