ABO blood group barrier in allogeneic bone marrow transplantation revisited.
Reports have shown a worse outcome for donor-recipient pairs mismatched for ABO blood groups in bone marrow transplantation (BMT). These studies, however, included small and heterogeneous study populations, and not all considered bidirectional ABO incompatibility separately. Because the issue remains controversial, we analyzed the effect of ABO mismatch on the overall survival, transplant-related mortality, and occurrence of acute and chronic graft-versus-host disease (GVHD) in a large homogenous group of patients undergoing allogeneic BMT. A total of 3103 patients with early-stage leukemia who underwent transplantation between 1990 and 1998 with bone marrow from an HLA-identical sibling and who were reported to the Center for International Blood and Marrow Transplant Research were studied. The median follow-up was 54 months. A total of 2108 (67.9%) donor-recipient pairs were ABO identical, 451 (14.5%) had a minor mismatch, 430 (13.9%) had a major mismatch, and 114 (3.7%) had a bidirectional ABO mismatch. The groups did not differ significantly in patient or donor characteristics except for more female-to-male sex mismatch in the bidirectional ABO mismatch group (P = .017). In multivariate models of overall survival, transplant-related mortality, and grade II to IV acute GVHD, there were no significant differences among the 4 groups. Bidirectional ABO mismatch was associated with a significantly higher risk of grade III or IV acute GVHD (hazard ratio, 1.869; 95% confidence interval, 1.192-2.93; P = .006). Patients with major ABO mismatch received red blood cell transfusions (P = .001) for a longer timer after transplantation and had a slightly slower neutrophil recovery (P < .001). There was no evidence of a substantial effect of ABO blood group incompatibility on the outcome of conventional BMT among patients with leukemia.
Seebach
Jörg D
JD
Department of Internal Medicine, University Hospital Zürich, Zürich, Switzerland.
Stussi
Georg
G
Passweg
Jakob R
JR
Loberiza
Fausto R
FR
Gajewski
James L
JL
Keating
Armand
A
Goerner
Martin
M
Rowlings
Philip A
PA
Tiberghien
Pierre
P
Elfenbein
Gerald J
GJ
Gale
Robert Peter
RP
van Rood
Jon J
JJ
Reddy
Vijay
V
Gluckman
Eliane
E
Bolwell
Brian J
BJ
Klumpp
Thomas R
TR
Horowitz
Mary M
MM
Ringdén
Olle
O
Barrett
A John
AJ
D000017:ABO Blood-Group System; D000293:Adolescent; D000328:Adult; D000368:Aged; D001788:Blood Grouping and Crossmatching; D016026:Bone Marrow Transplantation / Q000379:methods / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D017707:Erythrocyte Transfusion / Q000379:methods / Q000401:mortality; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D000017:ABO Blood-Group System