Platelet transfusion containing ABO-incompatible plasma and hepatic veno-occlusive disease after hematopoietic transplantation in young children.
BACKGROUND
Hepatic veno-occlusive disease is a major limiting factor of high-dose chemotherapy in children. The cells lining the hepatic vascular endothelium express blood group A and/or B antigens according to the patient's blood group. We designed a study evaluating the impact of platelet concentrates containing ABO-incompatible plasma transfused to young children with a high risk of hepatic veno-occlusive disease.


METHODS
In all, 186 consecutive children (median age: 4 years, range: 0.75-17 years), treated with high-dose chemotherapy containing busulfan followed by hematopoietic stem cell transplantation for neuroblastoma (n=112) or brain tumor (n=74) between 1988 and 1998, were investigated. The main endpoint was the occurrence of hepatic veno-occlusive disease. Multivariate analysis was performed using a Cox's regression model with transfusion of platelet concentrates containing ABO-incompatible plasma as a time-dependent covariate.


RESULTS
We found that 73 out of 186 (39%) children developed hepatic veno-occlusive disease after transplantation. Multivariate analysis demonstrated that two factors significantly increased the risk of hepatic veno-occlusive disease occurrence: transfusion of platelet concentrates containing ABO-incompatible plasma (P=0.003) and use of melphalan in the conditioning regimen (P=0.006). Conversely, the number of platelet concentrates transfusions per week, child's age, weight, sex, and use of cyclophosphamide in the conditioning regimen had no effect.


CONCLUSIONS
Transfusion of platelet concentrates containing ABO-incompatible plasma increases the risk of hepatic veno-occlusive disease in young children treated with a busulfan-containing regimen. Binding of A and/or B antigens expressed on the surface of hepatic endothelial cells may promote this complication. Transfusion of platelet concentrates containing ABO-incompatible plasma should be avoided in these children.
Lapierre
Valérie
V
Unité de Médecine Transfusionnelle et d'Hémovigilance, Institut Gustave Roussy, Villejuif, France. valerie.lapierre@efs.sante.fr
Mahé
Cédric
C
Aupérin
Anne
A
Stambouli
Férial
F
Oubouzar
Nadia
N
Tramalloni
Dominique
D
Benhamou
Ellen
E
Tiberghien
Pierre
P
Hartmann
Olivier
O
D000017:ABO Blood-Group System; D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects; D001932:Brain Neoplasms / Q000628:therapy*; D002066:Busulfan / Q000494:pharmacology; D056486:Chemical and Drug Induced Liver Injury; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000494:pharmacology; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006504:Hepatic Veno-Occlusive Disease / Q000139:chemically induced* / Q000628:therapy*; D006801:Humans; D007223:Infant; D008107:Liver Diseases / Q000628:therapy*; D008297:Male; D015999:Multivariate Analysis; D009447:Neuroblastoma / Q000628:therapy*; D017713:Platelet Transfusion / Q000379:methods*; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D019172:Transplantation Conditioning
D000017:ABO Blood-Group System; D000970:Antineoplastic Agents; D003520:Cyclophosphamide; D002066:Busulfan