title: Major ABO-incompatible BMT: isohemagglutinin reduction with plasma exchange is safe and avoids graft manipulation.
abstract: The impact of donor-recipient ABO incompatibility on long-term BMT outcomes remains controversial. A common strategy is to deplete the donor marrow of red cells, although this variably reduces the number of CD34+ cells. This 10-year retrospective study assessed the impact of recipient plasma exchange in major ABO-incompatible allogeneic BMT on outcomes and survival. Target Ab titres were ≤ 1:4 for anti-A and ≤ 1:8 for anti-B. Patients with higher titres underwent plasma exchange before marrow infusion. Of 133 patients who underwent allogeneic BMT, 34 had a major ABO-incompatible donor. The median number of exchanges was 2 (range 1-4). There were no acute haemolytic transfusion reactions. Engraftment times, transfusion requirements and acute and chronic GVHD were no different from those of patients with an ABO-identical donor. Treatment-related mortality at 100 days was 21% in the group with a major ABO-incompatible donor and 17% in the group with an identical donor (P=0.8). Plasma exchange of the recipient is a safe method of managing donor-recipient major ABO incompatibility before BMT without the risk of haematopoietic progenitor cell loss associated with red cell depletion of the graft.
authors: Division of Hematology, Department of Medicine, Blood and Marrow Transplant Program, The Ottawa Hospital, Ottawa, Ontario, Canada. dsheppard@toh.on.ca
authors: D
authors: D
authors: Sheppard
authors: J
authors: J
authors: Tay
authors: A
authors: A
authors: Bryant
authors: S
authors: S
authors: McDiarmid
authors: L
authors: L
authors: Huebsch
authors: M
authors: M
authors: Tokessy
authors: L
authors: L
authors: Hamelin
authors: E
authors: E
authors: Saidenberg
authors: C
authors: C
authors: Bredeson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts; D001787:Blood Group Incompatibility; D016026:Bone Marrow Transplantation; D002648:Child; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006388:Hemagglutinins; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D061349:Unrelated Donors
chemical_list: D006388:Hemagglutinins