Prolonged red cell aplasia after major ABO-incompatible allogeneic hematopoietic stem cell transplantation: removal of persisting isohemagglutinins with Ig-Therasorb immunoadsorption.
Delayed donor red cell engraftment and prolonged red cell aplasia (PRCA) are well-recognized complications of major ABO-incompatible myeloablative and non-myeloablative hematopoietic stem cell transplantation (HSCT). There is an intense debate about the impact on outcome, severity of hemolysis, association with graft-versus-host disease and survival after blood group-incompatible stem cell transplantation. Therefore, therapeutic strategies should be considered to avoid these possible complications. We present five patients, who received allogeneic HSCT from human leukocyte antigen-identical donors for hematological malignancies, which were treated with Ig-Therasorb immunoadsorption (five treatments/week) to remove persisting incompatible isohemagglutinins. After a median of 17 treatments (range 9-25), all the patients became transfusion independent with the presentation of donor's blood group. No side effects occurred during treatment. Ig-Therasorb immunoadsorption seems to be a promising therapeutic method for rapid, efficient and safe elimination for persisting isohemagglutinins for patients with PRCA after allogeneic hematological stem cell transplantation.
Rabitsch
W
W
Department of Medicine I, Bone Marrow Transplantation Unit, University of Vienna, Waehringer Guertel 18-20, Vienna A-1090, Austria. Werner.Rabitsch@akh-wien.ac.at
Knöbl
P
P
Prinz
E
E
Keil
F
F
Greinix
H
H
Kalhs
P
P
Worel
N
N
Jansen
M
M
Hörl
W H
WH
Derfler
K
K
D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D001787:Blood Group Incompatibility; D005260:Female; D006388:Hemagglutinins / Q000302:isolation & purification*; D019337:Hematologic Neoplasms / Q000150:complications / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006648:Histocompatibility; D006801:Humans; D007163:Immunosorbent Techniques; D008297:Male; D008875:Middle Aged; D012010:Red-Cell Aplasia, Pure / Q000209:etiology* / Q000628:therapy*; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D000017:ABO Blood-Group System; D006388:Hemagglutinins