Impact of ABO incompatibility on allogeneic peripheral blood progenitor cell transplantation after reduced intensity conditioning.
BACKGROUND
Most studies indicate that ABO incompatibility has no effect on the clinical outcome after allogeneic peripheral blood progenitor cell (PBPC) transplantation (allo-PBPCT). However, it carries additional risks of hemolytic reactions, delayed red blood cell (RBC) engraftment, and pure red cell aplasia (PRCA). Data on these events after reduced intensity conditioning (RIC) regimens are limited, but recent studies have suggested a higher transplant-related mortality (TRM) and morbidity in this setting.


METHODS
We investigated the impact of ABO-matching on the outcome of 77 patients included in a prospective RIC allo-PBPCT protocol, focusing on engraftment, transfusion requirements, graft-versus-host disease, TRM, and survival.


RESULTS
There were 17 (22%) minor and 8 (10%) major ABO-incompatible transplants. No graft failures were observed. After major ABO-incompatible grafts, RBC engraftment was delayed, longer thrombocytopenia periods were documented, and transfusion requirements increased. A transient mild hemolysis occurred in 10 patients, 7 (41%) minor and 3 (37%) major ABO-mismatched. A PRCA was observed in a O+ patient with a pretransplant anti-Jka, grafted from an A + Jka+ donor. Graft-versus-host disease, disease progression, and TRM were not affected by ABO matching.


CONCLUSIONS
ABO incompatibility was not associated with clinically relevant hemolysis after the RIC protocol used and did not impair the clinical outcome. PRCA was only observed in one patient, with a non-ABO RBC allo-antibody.
Canals
Carmen
C
Blood Bank, Hospital de Sant Pau, Barcelona, Spain. ccanals@hsp.santpau.es
Muñiz-Díaz
Eduardo
E
Martínez
Clara
C
Martino
Rodrigo
R
Moreno
Imma
I
Ramos
Adelaida
A
Arilla
Marina
M
Boto
Neus
N
Pastoret
Concepción
C
Remacha
Angel
A
Sierra
Jorge
J
Madoz
Pedro
P
D000017:ABO Blood-Group System; D000328:Adult; D000368:Aged; D001787:Blood Group Incompatibility; D017707:Erythrocyte Transfusion; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control; D006461:Hemolysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D017713:Platelet Transfusion; D012010:Red-Cell Aplasia, Pure / Q000453:epidemiology; D013921:Thrombocytopenia / Q000453:epidemiology; D018183:Transplantation Chimera; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D000017:ABO Blood-Group System