URD BMT is an effective treatment for children with poor-prognosis acute leukemia and should be considered for all high-risk patients. Early referral of patients is strongly recommended.
The management of hemotherapy in 31 cases of ABO- or Rh-incompatible bone marrow transplantation is described. Our experience confirms that ABO or Rh incompatibility does not adversely affect engraftment, patient survival, or incidence of graft-versus-host disease. Eighteen recipients with ABO antibodies against the donors' red cells (major incompatibility) were managed by different combinations of plasma exchange, transfusion of incompatible donor type red cells, and removal of donor-type red cells from the bone marrow before transplant. The only serious complication was delayed hemolysis in seven of nine patients who received incompatible red cell transfusions before transplant. Thirteen patients received bone marrow containing ABO antibodies against their red cells (minor incompatibility). Five were managed by centrifuging the bone marrow to remove plasma and reduce the amount of antibody. This did not cause substantial loss of stem cell activity (60-100% of original marrow), and no patients had complications related to the marrow transfusion. In contrast, two of seven patients who received uncentrifuged bone experienced hemolysis. Two of four Rh positive recipients who received marrow from an Rh negative donor developed anti-D, possibly due to Rh positive blood components transfused after transplantation. None of eight Rh negative patients who received an Rh positive transplant has developed anti-D. Blood components should be selected to avoid transfusion of incompatible red cells and to avoid transfusion of a large amount of incompatible plasma. This may necessitate use of plasma components of a different ABO type than the red cell components.
Summary:Allogeneic bone marrow transplantation is an effective treatment for acute lymphoblastic leukemia (ALL). 1 This efficacy is, in part, mediated by graft-versus-leukemia T and B lineage ALL cells express different levels of HLA-class II antigens, which may serve as targets for effects (GVL). 2,3 GVL is greatest in patients with acute or chronic graft-versus-host disease (GVHD). T cells are graft-versus-host disease (GVHD) and graft-versus-leukemia (GVL). The object of this study was to determine important in GVHD; 4 removing T cells from donor bone marrow greatly reduces the incidence and severity of whether GVL effects after HLA-identical sibling bone marrow transplantation differed in T and B lineage GVHD but increases the relapse risk. Different leukemias respond differently to GVL. The rea-ALL. We studied 1132 patients with ALL of T lineage (n = 416) or of B lineage (cALLa + ) (n = 716) transson for this is uncertain. Molecules on the surface of leukemia cells may determine susceptibility to GVL. 6 In experiplanted in first (n = 605) or second (n = 527) remission with bone marrow from an HLA-identical sibling mental models, major histocompatibility complex (MHC) class I expression is needed for a CD8 + T lymphocyte donor, between 1982 and 1992, and reported to the IBMTR by 165 teams. Cox proportional hazards response whereas MHC class II is required for both initiating the immune response and serving as a target for cytoregression models were used to determine the relative risk (RR) of relapse in patients with acute (grades IItoxic CD4 + T lymphocytes. [7][8][9][10][11] Experimental data suggest that alloreactive CD4 + lymphocytes are able to kill leuke-IV) or chronic GVHD vs patients without GVHD. Acute and chronic GVHD were considered as time-dependent mia cells. 12,13 In ALL, class II antigen expression (HLA-DR) differs significantly among leukemia phenotypes; it is covariates. Patients transplanted in first and second remission were analyzed separately. GVHD decreased highest in B lineage ALL and less or absent in T lineage ALL. [14][15][16][17][18] It is thus plausible that the antileukemia effect relapse risks to a similar extent in T and B lineage ALL. For first remission transplants, relative risks of relapse of GVHD might occur preferentially in the HLA class IIbearing B lineage leukemias. The object of this study was for patients with vs those without GVHD was 0.34 for T lineage ALL and 0.44 for B lineage ALL. Correspondto address this question by comparing the effects of GVHD on relapse rates in B lineage and T lineage ALL. ing relative risks in second remission transplants were 0.54 and 0.61. This study confirms earlier findings of an antileukemia effect of GVHD in ALL. This effect was similar in T lineage and B lineage ALL, despite probMaterials and methods able differences in HLA-class II antigen expression. Keywords: ALL; bone marrow transplantation; graftPatients versus-leukemia; T lineage; B lineage Between 1982Between and 1992Between , 1955
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