Association of ABO mismatch with the outcomes of allogeneic hematopoietic cell transplantation for acute leukemia

Abstract

Allogeneic hematopoietic cell transplantation (allo‐HCT) is a potentially curative treatment for acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). While many factors influence the outcomes of allo‐HCT, the independent impact of donor–recipient ABO mismatching remains unclear. Using the Center for International Blood and Marrow Transplant Research (CIBMTR) database, we identified patients aged ≥18 years with AML or ALL who underwent allo‐HCT between 2008 and 2018. Our objectives were to analyze the outcomes of allo‐HCT based on the donor–recipient ABO status (match, minor mismatch, major mismatch, bidirectional mismatch). Among 4946 eligible patients, 2741 patients (55.4%) were ABO matched, 1030 patients (20.8%) had a minor ABO mismatch, 899 patients (18.1%) had a major ABO mismatch, and 276 patients (5.6%) had a bidirectional ABO mismatch. In multivariable analyses, compared to ABO matched allo‐HCT, the presence of a major ABO mismatch was associated with worse overall survival (HR 1.16, 95% CI 1.05–1.29; p = 0.005), inferior platelet engraftment (HR 0.83, 95% CI 0.77–0.90; p < 0.001), and higher primary graft failure (HR 1.60, 95% CI 1.12–2.30, p = 0.01). Relapse, acute graft versus host disease (GVHD) grades III‐IV and chronic GVHD were not significantly associated with ABO status. While donor age was not significantly associated with outcomes, older recipient age was associated with worse survival and non‐relapse mortality. Our study demonstrates that donor–recipient ABO status is independently associated with survival and other post‐transplantation outcomes in acute leukemia. This underscores the importance of considering the ABO status in donor selection algorithms and its impact in acute leukemia.

Impact of myelofibrosis on patients with myelodysplastic syndromes following allogeneic hematopoietic stem cell transplantation

“…confirmed that major ABO incompatibility predicted a higher risk of NRM and poor OS in patients with MDS and AML [ 27 ]. In the context of human leukocyte antigen-matched transplantation, a major ABO mismatch was independently associated with survival in patients with acute leukemia [ 28 ]. Moreover, major ABO incompatibility was correlated with delayed multilineage engraftment, leading to a relative long-term transfusion dependence and increased NRM [ 29 ].…”

Case report: Successful treatment with daratumumab for pure red cell aplasia in a patient with mixed lymphoid chimerism after ABO-mismatched stem cell transplant for sickle cell disease

“…First, our patient needed weekly RBC transfusions and had a history of alloimmunization, putting him at risk of the formation of new alloantibodies. Second, major ABO incompatibility is associated with an increased risk of graft rejection (14,15). As such an immunologic process involved in PRCA might especially increase the risk of graft rejection in the setting of mixed chimerism, we decided to treat our patient with daratumumab as early as day +60 after transplantation.…”

Optimizing Access to Unrelated Donors in Canada: Re-Examining the Importance of Donor Factors on Outcomes Following Hematopoietic Cell Transplantation

“…Some transplant centers perform red cell reduction of the cell product, especially if the cell source is bone marrow [30], which has a greater hematocrit compared with peripheral blood progenitor cell products. A recent study by CIBMTR addressing ABO mismatch on transplant outcomes in patients with acute leukemia receiving related or unrelated donor transplants was recently reported [31]. Major ABO mismatch occurred in approximately 25% of transplants and was associated with worse overall survival (HR 1.16, 1.05-1.29, p = 0.005), inferior platelet engraftment, and increased risk of primary graft failure (HR 1.60, 1.12-2.30, p = 0.01).…”