Rapid engraftment after allogeneic ABO-incompatible peripheral blood progenitor cell transplantation complicated by severe hemolysis.
A patient with CML in accelerated phase received G-CSF-mobilized PBPC from an unrelated HLA genotypically matched donor. The blood groups of the patient and donor were bidirectionally incompatible. Hematologic recovery was rapid with > 500 PMN/microliter on day +9. Starting on day +5 bilirubin levels increased from 1.3 mg/dl up to a maximum of 18 mg/dl on day +14. Clinical signs and laboratory tests supported major hemolysis. Blood typing on day +16 revealed early blood-group change, consistent with donor-derived antibodies produced by passenger-lymphocytes which may have mediated severe hemolysis. The early onset and strong intensity of the hyperbilirubinemia could be a specific feature of ABO-incompatible allogeneic PBPC transplantation which would be difficult to differentiate from GVHD or VOD.
Bornhäuser
M
M
Department of Hematology/Oncology, Carl Gustav Carus Universität, Dresden, Germany.
Ordemann
R
R
Paaz
U
U
Schuler
U
U
Kömpf
J
J
Hölig
K
K
Ehninger
G
G
D000017:ABO Blood-Group System; D000328:Adult; D006085:Graft Survival; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006461:Hemolysis; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D014184:Transplantation, Homologous
D000017:ABO Blood-Group System