Changes of isoagglutinin titres after ABO-incompatible allogeneic stem cell transplantation.
We investigated the changes in isoagglutinin titres in 62 patients who underwent ABO-incompatible allogeneic stem cell transplantation. After major [and/or (+/-) minor] ABO-incompatible transplantation, recipient-derived isoagglutinins against donor-type red blood cells (RBCs) disappeared more rapidly in unrelated recipients (P = 0.006) and in patients with acute graft-versus-host disease (GVHD, P = 0.025) than in sibling recipients and in patients without acute GVHD respectively. Pure red cell aplasia (PRCA) developed in 10 out of 35 evaluable patients who underwent major (+/- minor) ABO-incompatible transplantation, and the post-transplant increase of isoagglutinin titres was a significant predictor for the occurrence of PRCA. In five out of 36 patients who underwent minor (and/or (+/-) major) ABO-incompatible transplantation, donor-derived isoagglutinins against recipient RBCs were detectable without clinically overt haemolysis. Isoagglutinin titres against ABO antigens absent both on recipient and donor RBCs decreased during the early post-transplant period then rose subsequently in 24 out of 29 patients at (median) d 59 post transplant. Our study showed that changes in isoagglutinin titres might have clinical implications in the occurrence of immunohaematological complications such as PRCA or immune-mediated haemolysis, and might reflect immunohaematological reconstitution after transplantation. Furthermore, our data regarding time to disappearance of recipient-derived isoagglutinins against donor-type RBCs after major ABO-incompatible transplantation suggest the presence of a graft-versus-plasma cell effect.
Lee
Je-Hwan
JH
Department of Medicine, Asan Medical Centre, University of Ulsan, Seoul, Korea. jhlee3@www.amc.seoul.kr
Lee
Jung-Hee
JH
Choi
Seong-Jun
SJ
Kim
Shin
S
Seol
Miee
M
Kwon
Seog-Woon
SW
Park
Chan-Jeoung
CJ
Chi
Hyun-Sook
HS
Lee
Jung-Shin
JS
Kim
Woo-Kun
WK
Lee
Kyoo-Hyung
KH
D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D001787:Blood Group Incompatibility / Q000276:immunology*; D004912:Erythrocytes / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012010:Red-Cell Aplasia, Pure / Q000276:immunology; D012307:Risk Factors
D000017:ABO Blood-Group System; D007518:Isoantibodies