Anti-A isoagglutinin as a risk factor for the development of pure red cell aplasia after major ABO-incompatible allogeneic bone marrow transplantation.
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 vsnon-PRCA, 200 vs 66 days) and in cases with anti-A isoagglutinins (anti-A vsanti-B, 160 vs 51 days). Times to disappearance of isoagglutinins correlated with times to reticulocytes over 1% and initial appearance of donor type RBC (R2 = 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.
Lee
J H
JH
Division of Oncology-Hematology, Department of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea.
Lee
K H
KH
Kim
S
S
Lee
J S
JS
Kim
S H
SH
Kwon
S W
SW
Kim
W K
WK
D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D000936:Antigen-Antibody Complex / Q000009:adverse effects / Q000276:immunology; D001787:Blood Group Incompatibility / Q000097:blood / Q000276:immunology*; D016026:Bone Marrow Transplantation / Q000009:adverse effects* / Q000276:immunology; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease; D006801:Humans; D007132:Immunoglobulin Isotypes / Q000276:immunology; D007518:Isoantibodies / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012010:Red-Cell Aplasia, Pure / Q000097:blood / Q000209:etiology* / Q000276:immunology; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D000017:ABO Blood-Group System; D000936:Antigen-Antibody Complex; D007132:Immunoglobulin Isotypes; D007518:Isoantibodies