Abo-Incompatible Marrow Transplant,s

104

103

Summary:Aside from causing hemolytic reactions the ABO blood group system does not have an impact on outcome after allogeneic bone marrow or peripheral blood stem cell transplantation (SCT). However, only a few studies have addressed the effect of ABO incompatibility on the incidence of GVHD, time to engraftment, relapse and survival. Therefore, we performed a retrospective twocenter analysis of 562 consecutive patients receiving allogeneic SCT, including 361 ABO-identical, 98 minor, 86 major and 17 bidirectional ABO-incompatible SCT. In multivariate analysis adjusted for potential confounders survival was significantly associated with ABO incompatibility (P = 0.006). Compared to ABO-identical SCT, bidirectional ABO incompatibility increased the risk significantly (RR, 2.8; 95% CI, 1.5-5.1; P = 0.0009), whereas survival of patients with minor (RR, 1.2; 95% CI, 0.9-1.7; P = 0.27), or major ABO-incompatible SCT (RR, 1.3; 95% CI, 0.9-1.8; P = 0.18) was not significantly different. RBC engraftment was delayed in major ABO-incompatible SCT (RR, 0.66; 95% CI, 0.51-0.85; P = 0.001). The incidence of acute GVHD (grade I-IV) was higher in minor ABO-incompatible SCT as compared to ABO identity (RR, 2.8; 95% CI, 1.3-5.9, P = 0.009). This difference was limited to mild GVHD; in moderate-to-severe GVHD (grade II-IV) no significant difference was found among the groups (P = 0.53). The relapse rate was not influenced by ABO incompatibility (P = 0.78). In conclusion, these results suggest that ABO incompatibility represents a risk factor not only for post-transplant hemolysis, but also for survival and the rate of mild GVHD after allogeneic SCT. In contrast to RBC transfusion and solid organ transplantation, approximately one-third of all allogeneic bone marrow or peripheral blood stem cell transplantations (SCT) are performed across the ABO blood group barrier. 1,2 There are three groups of ABO incompatibility: minor ABO incompatibility (eg from an O-type donor to an A-type recipient) is characterized by the ability of donor B lymphocytes to produce anti-recipient isoagglutinins. In clinical practice, preformed anti-host isoagglutinins are removed from the stem cell inoculum by centrifugation prior to transplantation. In contrast, major ABO-incompatible SCT (eg from an A-type donor to an O-type recipient) is characterized by the presence of preformed anti-donor isoagglutinins. In bidirectional ABO incompatibility (eg A-type donor to a B-type recipient), a combination of both the major and minor barrier has to be overcome.It is well known that ABO-incompatible SCT increases the risk of hemolytic reactions in all groups, 3 but it is believed that ABO incompatibility between donor and recipient is of no importance for the overall clinical outcome. [4][5][6][7] Nevertheless, over the past two decades, improvements in GVHD prophylaxis and transplantation technologies have led to a generally lower overall mortality, theoretically unraveling an effect of the ABO system on the outcome of SCT. In particular, there are several lines of ...

Section: Discussionsupporting

confidence: 89%

Section: Discussioncontrasting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

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Consequences of ABO incompatibility in allogeneic hematopoietic stem cell transplantation

Stüssi

Muntwyler

Passweg

et al. 2002

104

103

“…4,5 Basic immunohematology principles apply to the infusion of red cell incompatible HSC components -processing of the component or preparation of the recipient may be necessary to prevent hemolysis of donor or recipient red blood cells as a result of the infusion of incompatible red blood cells or plasma contained within the HSC component. [2][3][4][5][6][7][8] This, of course, applies only to those antigen systems capable of causing hemolytic transfusion reactions at body temperature. However, in contrast to blood transfusion, the risk of hemolysis occurs not only at the time of infusion but can also can occur later if viable lymphocytes in the HSC component produce isoagglutinins directed against recipient red cell antigens.…”

mentioning

confidence: 99%

Hematopoietic stem cell transplantation between red cell incompatible donor–recipient pairs

Rowley

2001

Summary:Transplantation between red cell-disparate donor and recipient is feasible with minimal increase in the risk of transplantation if consideration is given to the immunohematological consequences of the transplant. The risks of immediate and delayed hemolysis must be managed. Some recipients will experience a delay in the recovery of red blood cells. Bone Marrow Transplantation (2001) 28, 315-321.

“…5,6 However, several reports have described delayed hemolytic anemia, delayed onset of erythropoiesis and pure red cell aplasia (PRCA) after major ABO-incompatible allogeneic BMT. [7][8][9][10][11] We made an attempt to identify risk factors for the development of PRCA in patients who received a major ABO-incompatible bone marrow graft.…”

mentioning

confidence: 99%

Anti-A isoagglutinin as a risk factor for the development of pure red cell aplasia after major ABO-incompatible allogeneic bone marrow transplantation

Lee

Kim

et al. 2000

Summary:Delayed erythropoiesis and pure red cell aplasia (PRCA) have been reported after major ABO-incompatible BMT. We attempted to find risk factors for the development of PRCA in 27 patients who underwent major ABO-incompatible BMT. In all patients, the donor marrow was depleted of RBCs before infusion. In 22 patients, isoagglutinins were determined until they disappeared. In eight (29.6%) out of 27 patients, bone marrow examination following BMT showed the findings of PRCA. We analyzed various clinico-pathologic risk factors and isoagglutinin type was the only significant risk factor. Patients with anti-A isoagglutinins against donor RBC developed PRCA more frequently than patients with anti-B (8/17 vs 0/9). Median days to the disappearance of isoagglutinins tended to be longer in patients with PRCA (PRCA vs non-PRCA, 200 vs 66 days) and in cases with anti-A isoagglutinins (anti-A vs anti-B, 160 vs 51 days). Times to disappearance of isoagglutinins correlated with times to reticulocytes over 1% and initial appearance of donor type RBC (R 2 = 0.708 and 0.711). In conclusion, RBC engraftment following major ABO-incompatible BMT was dependent on the disappearance of isoagglutinins against donor RBC, and anti-A isoagglutinin was a risk factor for the development of PRCA after major ABO-incompatible allogeneic BMT. Bone Marrow Transplantation (2000) 25, 179-184. Keywords: anti-A isoagglutinin; PRCA; ABO-incompatible BMT Major donor-recipient ABO incompatibility is not considered to be a contraindication to successful bone marrow transplantation (BMT). Acute hemolysis by anti-A or anti-B isoagglutinins of recipient origin at the time of donor marrow infusion can effectively be prevented by the removal of anti-A or anti-B isoagglutinins from the recipients or by the depletion of red blood cells from marrow grafts. [1][2][3][4] Previous studies showed no significant effect of major ABO mismatch on the incidence of graft rejection, the incidence of graft-