The Effect of Minor Abo Mismatches on the Incidence of Graft-Versus-Host Disease After Allogeneic Bone Marrow Transplantation

Tr, Klumpp; Fairclough, Diane L.; Ritz, Jérôme; Soiffer, Robert J.

doi:10.1097/00007890-199403150-00031

Cited by 9 publications

(7 citation statements)

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“…Other studies, one of them using T cell depletion, also failed to demonstrate an effect of minor ABO incompatibility on the rate of moderate-to-severe GVHD (grade II-IV). 4,6,7,27 In line with these reports, we could not find an increased risk for grade II-IV GVHD in patients with minor or bidirectional ABO-incompatible SCT. Only when mild GVHD (grade I) was included in both univariate and multivariate analysis was an increased risk found for patients receiving minor ABO-incompatible SCT.…”

Section: Discussionsupporting

confidence: 87%

Consequences of ABO incompatibility in allogeneic hematopoietic stem cell transplantation

Stüssi

Muntwyler

Passweg

et al. 2002

Bone Marrow Transplant

104

103

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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 ...

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Section: Discussionsupporting

confidence: 87%

Consequences of ABO incompatibility in allogeneic hematopoietic stem cell transplantation

Stüssi

Muntwyler

Passweg

et al. 2002

Bone Marrow Transplant

104

103

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“…[13][14][15][16][17][18][19][20][21]33,34 However, the relative ease of testing for such correlations, the well-known and highly prevalent phenomenon of publication bias, and the presence of a number of studies in the literature that have failed to confirm such correlations [22][23][24][25][26][27][28][29][30][31][32] led us to hypothesize that publication bias itself may be partly or wholly responsible for the appearance of such reports in the literature. To our knowledge, the current study is the only investigation of these issues in the BMT literature in which the authors have specified a single, precisely defined primary statistical end point before initiating the actual analysis, and used formal statistical adjustments to reduce the risk of reporting false-positive associations involving secondary end points.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the current study may be more widely applicable than the CIBMTR study because the CIBMTR study included only patients with early-stage leukemia, whereas the current study included an unselected consecutive series of transplants and thus represents all of the commonly transplanted diagnoses. We and others have hypothesized 13,15,16,26 that minor ABO mismatches between BMT donors and recipients might be associated with an increased incidence of GVHD given the importance of the ABO system in the solid organ transplant setting and given the expression of recipientderived ABO antigens on essentially all host nucleated cells, which could potentially serve as a target for incoming donor T-cells. However, neither the current study nor the large recently published CIBMTR study 32 just mentioned supports this hypothesis.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12] However, the literature contains strikingly disparate opinions regarding the potential effect of ABO mismatching on other important outcome parameters including the incidence of death, relapse, graft-versus-host disease (GVHD), and transplant-related-mortality. Specifically, various investigators have concluded that ABO mismatching increases, [13][14][15][16][17][18][19][20][21] does not affect, [22][23][24][25][26][27][28][29][30][31][32] or decreases, [33][34] the incidence of one or more of the latter events.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Lack of effect of donor–recipient ABO mismatching on outcome following allogeneic hematopoietic stem cell transplantation

Klumpp

Herman

Ulicny

et al. 2006

Bone Marrow Transplant

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Several recently published studies have suggested that patients who undergo ABO mismatched hematopoietic stem cell transplantation may be at increased risk for relapse, graft-versus-host disease, transplant-related mortality, and/or all-cause mortality. To investigate this issue further, we analyzed potential associations between the donor-recipient ABO mismatch pattern and the above outcome measures among 240 consecutive patients who underwent allogeneic hematopoietic stem cell transplantation at our institution. Our analyses uncovered no significant associations between donor-recipient ABO mismatch pattern and overall survival, event-free survival, transplant-related mortality, incidence of acute graftversus-host disease (GVHD), or incidence of chronic GVHD. Our data do not support recent assertions that donor-recipient ABO mismatching is a major risk factor for patients undergoing allogeneic transplant, nor do they support recent assertions that ABO matching should be an important consideration in selecting allogeneic hematopoietic stem cell donors.

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“…Many reports have revealed no influence on engraftment. [1][2][3][4][5] However, conflicting data still exist as to its influence on transplant outcome, graft-versus-host disease (GVHD), 6-10 relapse [10][11][12] and survival. 10,[13][14][15][16] Major and minor ABO incompatibilities are associated with several immunohaematological complications such as immediate or delayed haemolysis, delayed erythropoiesis and pure red cell aplasia.…”

mentioning

confidence: 99%

ABO-incompatible bone marrow transplantation: a GITMO survey of current practice in Italy and comparison with the literature

Raimondi

Soli

Lamparelli

et al. 2004

Bone Marrow Transplant

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The Effect of Minor Abo Mismatches on the Incidence of Graft-Versus-Host Disease After Allogeneic Bone Marrow Transplantation

Cited by 9 publications

References 0 publications

Consequences of ABO incompatibility in allogeneic hematopoietic stem cell transplantation

Consequences of ABO incompatibility in allogeneic hematopoietic stem cell transplantation

Lack of effect of donor–recipient ABO mismatching on outcome following allogeneic hematopoietic stem cell transplantation

ABO-incompatible bone marrow transplantation: a GITMO survey of current practice in Italy and comparison with the literature

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