Prolonged isolated red blood cell transfusion requirement after allogeneic blood stem cell transplantation: identification of patients at risk.
BACKGROUND
Delayed donor red blood cell chimerism (DRCC), pure red blood cell aplasia (PRCA), and autoimmune hemolytic anemia (AIHA) are poorly documented complications after hematopoietic cell transplantation (HCT). The clinical variable "prolonged isolated red blood cell transfusion requirement" (PRTR) was evaluated as a trigger for an extended diagnostic workup.


METHODS
PRTR was defined as the need for red blood cell (RBC) transfusions beyond Day 60 after HCT. We analyzed 487 patients transplanted between 2000 and 2006. Median age was 37 years (range, 0-70 years). Peripheral blood stem cells (n = 344), marrow (n = 138), and cord blood (n = 5) from 278 unrelated and 209 family donors were used.


RESULTS
Univariate analysis identified age (incidence of 18.3% among elderly patients, 10.5% in adults, and 2.0% among children [p = 0.002]), ABO incompatibility (16.4% after major incompatible, 2.9% after minor incompatible, and 9.4% after ABO-compatible transplantations [p = 0.003]), conditioning (15.2% after reduced-intensity regimens vs. 7.3% after myeloablative conditioning; p = 0.006), donor type (13.2% after HLA-matched unrelated, 13.6% after mismatched unrelated, 5.7% after matched related, and 0.0% after mismatched related grafts; p = 0.026), and acute graft-versus-host disease (aGVHD; 7.1% with aGVHD vs. 12.5% without aGVHD; p = 0.046) as predisposing factors. In multivariate analysis minor ABO incompatibility (odds ratio [OR] = 0.2, p = 0.01), younger age (OR = 0.1, p = 0.02), and matched related HCT (OR = 0.4, p = 0.02) remained independent protective factors.


CONCLUSIONS
PRTR could serve as a trigger for a standardized screening for DRCC, PRCA, and AIHA after HCT.
Dahl
Daphne
D
Departments of Pediatric Hematology/Oncology, Medizinische Hochschule Hannover, Hannover, Germany.
Hahn
Andreas
A
Koenecke
Christian
C
Heuft
Hans-Gert
HG
Dammann
Elke
E
Stadler
Michael
M
Buchholz
Stefanie
S
Krauter
Jürgen
J
Eder
Matthias
M
Sykora
Karl-Walter
KW
Klein
Christoph
C
Ganser
Arnold
A
Sauer
Martin
M
D000017:ABO Blood-Group System; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000744:Anemia, Hemolytic, Autoimmune / Q000209:etiology / Q000628:therapy*; D001787:Blood Group Incompatibility / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation; D017707:Erythrocyte Transfusion; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D012010:Red-Cell Aplasia, Pure / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D018183:Transplantation Chimera; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
D000017:ABO Blood-Group System