Autoimmune hemolityc anemia after treatment of severe systemic lupus erythematosus with high-dose chemotherapy and autotransplantation of selected peripheral hematopoietic progenitors.

Bone marrow transplantation is an emerging tool for treatment of immune-mediated diseases. The use of animal models have shown that these diseases can be treated by hematopoietic stem cell transplantation. These findings have recently been confirmed in humans; diseases like multiple sclerosis, rheumatoid arthritis and systemic lupus erythematosus were resolved or alleviated after allogeneic or autologous stem cell transplantation. We described here a patient with longstanding and refractory SLE in whom clinical and serological remission was achieved after a CD34 cell autotransplantation. However, she relapsed 5 months later with a severe AIHA, a clinical manifestation not previously recognized in the course of the patient’s disease. She was treated by prednisone and cyclophosphamide without success. Only with the administration of anti-CD20 (Rituximab) the AIHA partially resolved. This case reflects the necessity of controlled protocols to known not only the benefits of these potent therapies, but also their possible unwanted effects.