Hemotherapy in patients undergoing blood group incompatible bone marrow transplantation

Abstract

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.

Consequences of ABO incompatibility in allogeneic hematopoietic stem cell transplantation

“…18,19 In contrast, although anti-A/B antibodies may cause hemolysis and delayed RBC engraftment after ABO-incompatible SCT, they seem not to affect the overall outcome. 1,2,6,11 This notion is mainly based on the results of older studies showing no association between ABO incompatibility and mortality. [4][5][6] In contrast, we observed an impaired survival after bidirectional ABOincompatible SCT, but not in the minor or major ABOincompatible groups.…”

“…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.…”

AB0-incompatible allogeneic hematopoietic stem cell transplantation

“…This year is the right time to celebrate a significant anniversary of HSCT, as the first two successful transplants were performed just 40 years ago, in 1968. 1,2 The first patient had a form of sex-linked lymphopenic immunological deficiency, and, at five months of age, was transplanted with bone marrow (BM) cells of his sister, aged eight years. 1 The second was a child with Wiskott-Aldrich syndrome, who, at the age of two years, received the allograft from a sister, herself an X-trisomic (47, XXX) child.…”

“…1,2 The first patient had a form of sex-linked lymphopenic immunological deficiency, and, at five months of age, was transplanted with bone marrow (BM) cells of his sister, aged eight years. 1 The second was a child with Wiskott-Aldrich syndrome, who, at the age of two years, received the allograft from a sister, herself an X-trisomic (47, XXX) child. 2 The demonstration of histocompatibility between donor and recipient was obtained through the tests of mixed lymphocyte culture, and of lymphocytotoxic assay in the first case, 1 while in the second pair, the reciprocal non-stimulation between the patient's lymphocytes and those of his sister was verified repeatedly, also with extensive controls.…”

Bleeding risk and platelet transfusion refractoriness in patients with acute myelogenous leukemia who undergo autologous stem cell transplantation

“…12 Non-leukoreduced pooled random donor platelet concentrates, given under generally accepted institutional guidelines, were used for most transfusions. The dose of platelets was one platelet concentrate per 10 kg body weight, up to a maximum of six platelet concentrates.…”