Immunohematologic Consequences of Major Abomismatched Bone Marrow Transplantation

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-

Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

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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

“…Reported effects of ABO incompatibility include impaired survival, 2,7-9 immunohaematological reactions 10,11 and increased rates of GVHD. 2,8,[12][13][14] Immunological effects of ABO BD and MJ mismatch include acute haemolysis, pure red cell aplasia and delayed engraftment, leading to increased transfusion requirements.…”

Section: Introductionmentioning

confidence: 99%

Impact of ABO blood group mismatch in alemtuzumab-based reduced-intensity conditioned haematopoietic SCT

Brierley

Littlewood

Peniket

et al. 2015

The impact of ABO incompatibility on clinical outcomes following haematopoietic SCT (HSCT) remains controversial. This retrospective study assessed the effect of ABO mismatch on transplant outcomes and transfusion requirements in 594 patients undergoing reduced-intensity conditioned (RIC) HSCT with alemtuzumab in three UK transplant centres. We found no significant effects of minor, major or bidirectional ABO mismatch on overall survival, relapse-free survival, nonrelapse mortality or relapse incidence. Although the rate of acute GVHD was unaffected by ABO mismatch, the incidence of extensive chronic GVHD was higher in patients with minor and major mismatch compared with those who were ABO matched (hazard ratio (HR) 1.74, P = 0.032 for minor, HR 1.69 P = 0.0036 for major mismatch). Red cell and platelet transfusion requirements in the first 100 days post transplant did not differ by ABO mismatch. In this large UK series, ABO mismatch in RIC HSCT has no clinically significant effect on survival outcomes but appears to modify susceptibility to extensive chronic GVHD.Bone Marrow Transplantation (2015) 50, 931-938;

“…1 Although time to neutrophil and platelet engraftment, incidence of GVHD, and survival are not affected by ABO incompatibility, 2 pure red cell aplasia (PRCA) is seen in about 15-20% of HLAmatched major ABO-incompatible pairs. [3][4][5] PRCA after major ABO-incompatible HSCT does not usually need any treatment except for transfusion of RBC, but may require other treatments if it persists. PRCA as a complication of major ABO-incompatible HSCT is sometimes difficult to treat.…”

mentioning

confidence: 99%

Treatment of pure red cell aplasia after major ABO-incompatible peripheral blood stem cell transplantation by induction of chronic graft-versus-host disease

Yamaguchi

Sakai

Murata

et al. 2002

Summary:This report concerns a case of long-lasting pure red cell aplasia (PRCA) with a duration of 178 days after major ABO-incompatible allogeneic peripheral blood stem cell transplantation (PBSCT). The patient needed red blood cell transfusion every week from day 54 following PBSCT. He showed no evidence of GVHD and the dose of cyclosporin A (CsA) was reduced rapidly from day 123, followed by the development of chronic GVHD around day 145. The patient no longer needed transfusions from day 167, the reticulocyte count began to increase on day 179, and antidonor isohemagglutinin titers became undetectable. Chronic GVHD induced by tapering of CsA thus appeared to be related to improvement in PRCA.