Prolonged red cell aplasia after major ABO-incompatible allogeneic hematopoietic stem cell transplantation: removal of persisting isohemagglutinins with Ig-Therasorb® immunoadsorption

Abstract

Summary:Delayed donor red cell engraftment and prolonged red cell aplasia (PRCA) are well-recognized complications of major ABO-incompatible myeloablative and nonmyeloablative hematopoietic stem cell transplantation (HSCT). There is an intense debate about the impact on outcome, severity of hemolysis, association with graft-versus-host disease and survival after blood group-incompatible stem cell transplantation. Therefore, therapeutic strategies should be considered to avoid these possible complications. We present five patients, who received allogeneic HSCT from human leukocyte antigen-identical donors for hematological malignancies, which were treated with IgTherasorb s immunoadsorption (five treatments/week) to remove persisting incompatible isohemagglutinins. After a median of 17 treatments (range 9-25), all the patients became transfusion independent with the presentation of donor's blood group. No side effects occurred during treatment. Ig-Therasorb s immunoadsorption seems to be a promising therapeutic method for rapid, efficient and safe elimination for persisting isohemagglutinins for patients with PRCA after allogeneic hematological stem cell transplantation.

Impact of AB0-blood group incompatibility on the outcome of recipients of bone marrow transplants from unrelated donors in the Japan Marrow Donor Program

“…13 Delayed recovery of red blood cells in AB0-major mismatched transplantation is a well-known problem and is caused by persistent anti-A/B against non-self-AB0 antigens. 14,15 We found delayed recovery not only of red blood cells but also of neutrophils and platelets. A previous report documented a longer period of thrombocytopenia in cases of major AB0 incompatibility.…”

Clinical Observation of Factors in the Efficacy of Blood Component Transfusion in Patients following Hematopoietic Stem Cell Transplantation

“…When allo-HSCT patients receive RBC transfusion from a major ABO incompatible blood source, the rebuild of the erythroid system was found to be slow [21], [22]. However, the incidence rate of GVHD was not significantly affected [23].…”

Immunoadsorption of factor VIII inhibitors

“…These include removal of persisting isohemagglutinins in red blood cell aplasia after ABOincompatible hematopoietic stem cell transplantation, low-density lipoprotein in hyperlipidemias, mercury toxicity, pemphigus, and dilated cardiomyopathy [60][61][62][63][64][65][66]. Increasingly, specific epitopes can be defined for the corresponding pathogenetic autoantibodies, and such epitopes can be used as a lead structure for the development of a specific peptide ligand in an immunoadsorption device that avoids the temporary humoral immunosuppression caused by the removal of immunoglobulin.…”