title: Allogeneic peripheral blood stem cell transplantation using reduced-intensity conditioning in an outpatient setting in ABO-incompatible patients: are survival and graft-versus-host disease different?
abstract: BACKGROUND
  Graft-versus-host disease (GVHD) is a major cause of morbimortality after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Minor ABO incompatibility has been associated with an increased risk of GVHD. We analyzed the impact of ABO matching on patient outcome after peripheral blood, reduced-intensity allo-HSCT in an outpatient setting, and its relationship with GVHD.
  
  
  METHODS
  Data of 121 patients were included. All patients received allo-HSCT from HLA-identical siblings as outpatients using a reduced-intensity conditioning regimen. Influence of ABO matching as a risk factor for the development of GVHD and survival was analyzed using logistic regression and Cox proportional hazards regression, respectively.
  
  
  RESULTS
  Median age was 36 years (range, 1-71 years); 88 patients were ABO identical: 13 presented major mismatch and 20 minor mismatch, with an ABO incompatibility rate of 27.3%. The median follow-up period was 54 months (range, 0.3-120 months). Minor ABO incompatibility patients presented the highest rate of acute GVHD (aGVHD; 25%), in comparison with ABO-identical (20.5%) and major ABO incompatibility patients (15.4%; p = 0.79). The highest incidence of chronic GVHD (cGVHD) occurred in the context of minor ABO incompatibility (35%), in contrast to ABO-identical (30.8%) and major ABO incompatibility (15.4%). Survival was higher for patients in the minor ABO mismatch group; however, there was no significant correlation between ABO matching status and survival (p = 0.45).
  
  
  CONCLUSIONS
  Using this type of peripheral blood stem cell transplantation, minor ABO-mismatched allo-HSCT was associated with a higher incidence of aGVHD and cGVHD and with increased survival, albeit with no significance.
authors.affiliation: Hematology Service, Internal Medicine Department, Hospital Universitario "Dr. José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México.
authors.forename: Cesar Homero
authors.initials: CH
authors.lastname: Gutiérrez-Aguirre
authors.forename: Andrés
authors.initials: A
authors.lastname: Gómez-De-León
authors.forename: Julio
authors.initials: J
authors.lastname: Alatorre-Ricardo
authors.forename: Olga Graciela
authors.initials: OG
authors.lastname: Cantú-Rodríguez
authors.forename: Oscar
authors.initials: O
authors.lastname: González-Llano
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Jaime-Pérez
authors.forename: Consuelo
authors.initials: C
authors.lastname: Mancías-Guerra
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Flores-Jiménez
authors.forename: David
authors.initials: D
authors.lastname: Gómez-Almaguer
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001787:Blood Group Incompatibility / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology* / Q000401:mortality; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
chemical_list: D000017:ABO Blood-Group System