Hematopoietic stem cell transplantation between red cell incompatible donor–recipient pairs

Rowley, SD

doi:10.1038/sj.bmt.1703135

Cited by 82 publications

(91 citation statements)

References 34 publications

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“…18 This strategy, however, involves additional manipulation of the marrow product and may be associated with significant total nucleated cell loss. 2 This may be of particular concern if the progenitor cell content of the graft is low, potentially leading to poorer transplant outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…However, even using modern apheresis techniques, this results in the recovery of only 10-60% of the total nucleated cells. 2 Furthermore, the manipulated product generally still contains 5-40 mL of red cells, 2,14 although a volume that is generally agreed to be safe to infuse has not been defined. An alternative approach is to reduce the recipient's isohemagglutinin titre through plasma exchange, replacing with AB plasma or albumin; column immunoadsorption; or in vivo immunoadsorption using donor ABO-incompatible red cells.…”

Section: Introductionmentioning

confidence: 99%

“…1 When BM is used as the source of progenitor cells, red cells may constitute 25-35% of the unmanipulated product volume. 2 Without intervention, the infusion of such a large red cell volume along with the progenitor cell product may lead to acute haemolysis or other complications, such as delayed red cell engraftment or pure red cell aplasia (PRCA). 3,4 The literature provides inconsistent conclusions about the effect of donor-recipient ABO incompatibility on haematopoietic progenitor cell transplant outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Major ABO-incompatible BMT: isohemagglutinin reduction with plasma exchange is safe and avoids graft manipulation

Sheppard

Tay

Bryant

et al. 2013

Bone Marrow Transplant

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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 þ 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 werep1:4 for anti-A andp1:8 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 ¼ 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.Bone Marrow Transplantation (2013) 48, 953-957;

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Major ABO-incompatible BMT: isohemagglutinin reduction with plasma exchange is safe and avoids graft manipulation

Sheppard

Tay

Bryant

et al. 2013

Bone Marrow Transplant

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“…4 This is most clinically relevant when BM is the source of stem cells as 25-35% of the graft will be red cells. 7 PBSCs are contaminated with only small numbers of red cells, usually at a level that is not clinically relevant. The Foundation for the Accreditation of Cellular Therapy (FACT) guidelines do not dictate how ABO and Rh incompatible cellular therapy products should be processed but states that the processing facility must have a policy regarding management of products that are ABO and/or Rh incompatible.…”

Section: Discussionmentioning

confidence: 99%

Major ABO incompatible BMT in children: determining what residual volume of donor red cells can safely be infused following red cell depletion

Patrick

Lau

Gassas

et al. 2015

Bone Marrow Transplant

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Major ABO incompatible BM transplantation carries a risk of acute haemolysis. Red cell depletion reduces this risk but not all incompatible RBC (iRBCs) are removed and in children the residual volume can be significant relative to body weight. We sought to determine the volume of iRBCs that can be safely given to children. All patients receiving fresh BM from a donor with a major ABO blood group mismatch between January 2000 and July 2013 at the Hospital for Sick Children, Toronto, were included. Seventy-eight patients were identified. The median volume of iRBCs transfused was 1.6 mL/kg (range 0.1-10.6 mL/kg). Thirty-five patients had minor haemolytic events and five patients had clinically significant adverse events. Two patients, who received 3.66 and 3.9 mL iRBCs/kg, developed renal impairment and in one case hypoxia and hyperbilirubinaemia. One patient had mild hypotension that resolved with i.v. fluid. Two patients developed hypotension secondary to sepsis and unrelated to BM infusion. Although signs of haemolysis occur, with appropriate hydration and monitoring of renal function, clinically significant adverse events related to the infusion of ABO incompatible BM are rare, and, in this study, were only seen in patients receiving 43 mL/kg of iRBCs per kg.Bone Marrow Transplantation (2015) 50, 536-539; doi:10.1038/bmt.2014.309; published online 26 January 2015 INTRODUCTION ABO incompatibility between donor and recipient is not a contraindication to allogeneic haematopoietic SCT (HSCT). However, a number of immunohaematological issues must be carefully considered and appropriately managed. 1 Major ABO mismatch is characterised by preformed recipient isoagglutinins to donor red cell antigens, and minor ABO mismatch occurs when the graft contains isoagglutinins directed against recipient red cells. Bidirectional mismatch occurs when both situations are present. 1 The risks of major ABO incompatibility include acute haemolysis at the time of graft infusion, delayed engraftment and pure red cell aplasia. 2 The literature suggests that 20-30 mL of incompatible RBCs (iRBCs) can be safely infused into an adult 2 and this has been extrapolated to 0.2-0.4 mL/kg, but there is no evidence about safe volumes in children. In the case of major ABO incompatibility, most centres will red cell deplete donor BM using centrifugation or sedimentation techniques. 2 Even with the best available technology it is not possible to remove all iRBCs and in small children this can result in a volume of red cells per kilogram of wt that is significantly higher than would routinely be transfused into an adult. In our experience we are rarely able to red cell deplete BM such that 40.4 mL/kg of iRBCs remain, without significantly reducing the total nucleated cell dose and thus jeopardising engraftment. Therefore, we sought to determine what volume of iRBCs can safely be given to children in the context of allogeneic HSCT using fresh BM.

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“…A second centrifugation (wash procedure) can be helpful if the donor has a particularly high titer anti-ABO antibody ( ⩾1:256). 27 If supporting an allogeneic program that utilizes unrelated donor products from around the world, the processing lab is often responsible (in most regulatory frameworks) for making sure that the donor screening and donor testing results confirm donor eligibility. Donor eligibility rules vary internationally, but most involve testing the donor within a few weeks (typically 4) of donation for the presence of infectious agents, such as HIV 1 and 2, HTLV 1 and 2, Hepatitis B, Hepatitis C, West Nile Virus and Syphilis, in a concerted effort to prevent the spread of infectious disease from donor to recipient.…”

Section: Personnelmentioning

confidence: 99%

Essential requirements for setting up a stem cell processing laboratory

Leemhuis

Padley

Keever-Taylor

et al. 2014

Bone Marrow Transplant

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Hematopoietic stem cell transplantation between red cell incompatible donor–recipient pairs

Cited by 82 publications

References 34 publications

Major ABO-incompatible BMT: isohemagglutinin reduction with plasma exchange is safe and avoids graft manipulation

Major ABO-incompatible BMT: isohemagglutinin reduction with plasma exchange is safe and avoids graft manipulation

Major ABO incompatible BMT in children: determining what residual volume of donor red cells can safely be infused following red cell depletion

Essential requirements for setting up a stem cell processing laboratory

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