Erythrocyte repopulation after major ABO incompatible transplantation with lymphocyte-depleted bone marrow.
Forty-four out of 258 allogeneic BMT were performed across the major ABO barrier. Donor erythrocyte repopulation could be evaluated in 30 cases. Fifty-eight patients transplanted with an ABO compatible or minor incompatible graft served as the control group. All patients received a marrow graft depleted of lymphocytes by counterflow centrifugation. Less than 10(8) residual erythrocytes were present in the graft. Cyclosporin A was used as immunoprophylaxis after transplantation. Erythrocyte repopulation was measured using a fluorescent microsphere method. An adapted transfusion policy was applied. Eight out of 30 patients (27%) with major ABO incompatibility had no detectable donor erythrocytes 2 months after BMT. Up to 3 months after BMT donor erythrocyte repopulation was significantly delayed in the ABO incompatible group (P < or = 0.03). Significantly more erythrocyte transfusions were required in the ABO incompatible group (P < 0.001). Six patients with blood group O (20%) developed pure red cell aplasia which resolved in five without therapeutic intervention. In these six patients anti-A antibody titers were persistently high the first 3 months after BMT. This was in contrast with 22 patients with timely recovery of erythropoiesis in whom anti-A and anti-B antibody titers showed a steady decrease after BMT. The incidence of immunohematological complications in these patients who received a lymphocyte depleted major ABO incompatible graft is similar (20%) to the incidence reported in the literature. Serious morbidity related to major ABO incompatibility did not occur.
Bär
B M
BM
Division of Haematology, University Hospital Nijmegen, The Netherlands.
Van Dijk
B A
BA
Schattenberg
A
A
de Man
A J
AJ
Kunst
V A
VA
de Witte
T
T
D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D001853:Bone Marrow / Q000276:immunology / Q000473:pathology*; D016026:Bone Marrow Transplantation; D002452:Cell Count; D004912:Erythrocytes / Q000473:pathology*; D004920:Erythropoiesis; D006801:Humans; D008214:Lymphocytes / Q000473:pathology; D013997:Time Factors
D000017:ABO Blood-Group System