A Cold Case: Cold Agglutinin Disease Complicating Stem Cell Transplant

Area of Science:

• Hematology
• Immunology
• Transplant Science

Background:

• Allogeneic hematopoietic cell transplants (HCTs) are curative for hematologic diseases.
• Stem cell infusion reactions are common but usually mild.
• Poor graft function (PGF) can occur post-HCT.

Purpose of the Study:

• To report a rare case of secondary cold agglutinin syndrome (CAS) in a stem cell donor.
• To describe the impact of donor CAS on recipient graft function.
• To emphasize the importance of donor evaluation in HCT.

Main Methods:

• Case report of a 27-year-old patient with T-cell acute lymphoblastic leukemia (ALL).
• Patient received a 9/10 HLA-mismatched unrelated peripheral blood stem cell transplant.
• Donor developed an upper respiratory infection and CAS prior to donation.

Main Results:

• Recipient experienced infusion reactions (fever, tachycardia, hypertension).
• Initial engraftment was observed, but the patient had persistent transfusion dependence (PGF).
• A second CD34-selected stem cell boost from a CAS-negative donor led to successful engraftment.

Conclusions:

• Donor-derived CAS is a rare but significant complication impacting HCT outcomes.
• Comprehensive donor screening and management are crucial to prevent PGF.
• Successful engraftment can be achieved with subsequent CAS-negative stem cell support.