Isoagglutinins following ABO‐Incompatible Bone Marrow Transplantation

Wernet, Dorothee; Mayer, Gerhard

doi:10.1111/j.1423-0410.1992.tb01194.x

Cited by 30 publications

(28 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…All cases of PRCA in this study involved group A donors and group O recipients, and anti-A isohemagglutinins persisted longer than anti-B isohemagglutinins following NST, as reported previously in myeloablative SCT. 16,17,38 These observations may reflect higher baseline levels of anti-A versus anti-B isohemagglutinins, 38 increased cell surface density of A compared with B antigens on the RBC membrane, 40 or increased complement-fixing capacity of red-cell-bound anti-A compared with anti-B. 41 We also observed a strong association between the pre-NST isohemagglutinin titer and the time until posttransplantation isohemagglutinins decreased to levels causing minimal agglutination on standard serologic assays.…”

Section: Discussionmentioning

confidence: 73%

“…The time of onset of donor red cell chimerism and the pace of decline in antidonor isohemagglutinins following myeloablative conditioning in this study were similar to those reported from prior series using dose-intensive conditioning. 4,6,16,17,[36][37][38][39] Posttransplantation erythropoietic function was strongly affected by the pace of decline in host antidonor isohemagglutinins, which fell to clinically insignificant levels more slowly after major ABO-incompatible NST than after myeloablative SCT. NST patients with persistent antidonor isohemagglutinins who experienced an early conversion to full donor (loss of recipient) myeloid chimerism developed PRCA, while those with later conversion were protected from PRCA by a sustained bridge of autologous erythropoiesis.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Delayed donor red cell chimerism and pure red cell aplasia following major ABO-incompatible nonmyeloablative hematopoietic stem cell transplantation

Bolan

Leitman

Griffith

et al. 2001

Blood

175

148

View full text Add to dashboard Cite

Delayed donor red cell engraftment and pure red cell aplasia (PRCA) are wellrecognized complications of major ABOincompatible hematopoietic stem cell transplantation (SCT) performed by means of myeloablative conditioning. To evaluate these events following reducedintensity nonmyeloablative SCT (NST), consecutive series of patients with major ABO incompatibility undergoing either NST (fludarabine/cyclophosphamide conditioning) or myeloablative SCT (cyclophosphamide/high-dose total body irradiation) were compared. Donor red blood cell (RBC) chimerism (initial detection of donor RBCs in peripheral blood) was markedly delayed following NST versus myeloablative SCT (median, 114 versus 40 days; P < .0001) and strongly correlated with decreasing host antidonor isohemagglutinin levels. Antidonor isohemagglutinins declined to clinically insignificant levels more slowly following NST than myeloablative SCT (median, 83 versus 44 days; P ‫؍‬ .03). Donor RBC chimerism was delayed more than 100 days in 9 of 14 (64%) and PRCA occurred in 4 of 14 (29%) patients following NST, while neither event occurred in 12 patients following myeloablative SCT. Conversion to full donor myeloid chimerism following NST occurred significantly sooner in cases with, compared with cases without, PRCA (30 versus 98 days; P ‫؍‬ .008). Cyclosporine withdrawal appeared to induce graftmediated immune effects against recipient isohemagglutinin-producing cells, resulting in decreased antidonor isohemagglutinin levels and resolution of PRCA following NST. These data indicate that significantly delayed donor erythropoiesis is (1) common following major ABO-incompatible NST and (2) IntroductionThe ABO blood group system is of critical importance in transfusion medicine, but has had less dramatic impact in hematopoietic transplantation. 1-4 ABO antigens are potently immunogenic and are expressed on multiple tissues in addition to red blood cells (RBCs). 5 Human beings begin to produce isohemagglutinins against non-self-ABO antigens shortly after birth and continue to do so throughout adult life. 1 Since ABO and human leukocyte antigens (HLAs) are inherited independently, ABO incompatibility may occur in up to 20% to 40% of HLA-matched allogeneic hematopoietic stem cell transplants (SCTs). 4 Graft failure does not occur with increased frequency, and most studies indicate that the incidence of graft-versus-host disease (GVHD) is also not increased following ABO-incompatible versus ABO-identical SCT. 2,4,6 Although increased transfusion requirements and immunohematologic events occur, the overall impact of ABO incompatibility in SCT is generally considered low, provided that appropriate transfusion practices are followed. 2,4,[7][8][9][10] Major ABO incompatibility in SCTs, defined as incompatibility of donor ABO antigens with the recipient's immune system, has been associated with pure red cell aplasia (PRCA) following conventional myeloablative conditioning. [11][12][13][14][15][16][17] Proposed risks for PRCA in this setting include the use of cyclosporine ...

show abstract

Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Delayed donor red cell chimerism and pure red cell aplasia following major ABO-incompatible nonmyeloablative hematopoietic stem cell transplantation

Bolan

Leitman

Griffith

et al. 2001

Blood

175

148

View full text Add to dashboard Cite

show abstract

“…The only two risk factors identified were a lack of pretransplant isoagglutinin reduction and the blood group constellation A or AB donor into an O group recipient. A review of the published literature identified 128 patients with PRCA in 18 case series [11][12][13]15,[20][21][22][23][24][25][26][27][28][29][30][31][32][33] and 35 case reports 16,18,19, with an overall incidence of 15% (range, 2-50%). 12,22 However, this may overestimate the true incidence due to a publication bias.…”

confidence: 99%

Prevention of pure red cell aplasia after major or bidirectional ABO blood group incompatible hematopoietic stem cell transplantation by pretransplant reduction of host anti-donor isoagglutinins

Stüssi¹,

Halter²,

Bucheli

et al. 2009

Haematologica

View full text Add to dashboard Cite

BackgroundPersistent anti-donor isoagglutinins after major ABO blood group incompatible hematopoietic stem cell transplantation may cause delayed red blood cell engraftment and post-transplant pure red cell aplasia. Design and MethodsWe investigated the effect of pretransplant anti-donor isoagglutinin reduction by in vivo absorption and/or plasmapheresis on the incidence of pure red cell aplasia and the time to red blood cell engraftment in 153 hematopoietic stem cell transplant recipients with major ABO incompatibility. ResultsTwelve patients (8%) developed pure red cell aplasia, 3/98 (3%) with, and 9/55 (16%) without prior isoagglutinin reduction (p=0.009). Red blood cell engraftment was faster in patients with isoagglutinin reduction; in addition, peripheral blood hematopoietic stem cell transplantation, acute graft-versus-host disease, and younger age were associated with faster red blood cell engraftment in Cox regression analysis. In patients with pure red cell aplasia the mean red blood cell engraftment occurred after 225 days (p<0.001) and was associated with a simultaneous decrease of anti-donor isoagglutinins. Patients with pure red cell aplasia had higher pretransplant anti-donor isoagglutinin titers (p=0.001) and received more post-transplant red blood cell transfusions (p<0.001). ConclusionsFollowing major ABO incompatible hematopoietic stem cell transplantation, pure red cell aplasia and delayed red blood cell engraftment depend on the levels of anti-donor isoagglutinins and are efficiently prevented by the pretransplant removal of these isoagglutinins. The benefits of reducing the time of transfusion-dependency and transfusion-associated risks must be carefully balanced against the potential side effects of isoagglutinin reduction.Key words: ABO blood group incompatibility, allogeneic hematopoietic stem cell transplantation, pure red cell aplasia.Citation: Stussi G, Halter J, Bucheli E, Valli PV, Seebach L, Gmür J, Gratwohl A, Schanz U, Passweg JR, and Seebach JD. Prevention of pure red cell aplasia after major or bidirectional ABO blood group incompatible hematopoietic stem cell transplantation by pretransplant reduction of host anti-donor isoagglutinins. Haematologica 2009; 94:239-248. doi:10.3324/haematol.13356 ©2009 Ferrata Storti Foundation. This is an open-access paper.Prevention of pure red cell aplasia after major or bidirectional ABO blood group incompatible hematopoietic stem cell transplantation by pretransplant reduction of host anti-donor isoagglutinins

show abstract

“…40,56 The most frequent problem relating to minor ABO incompatibility is delayed haemolysis due to the production of IHAs by the donor lymphocytes. [57][58][59][60][61][62] Delayed haemolysis is independent of the pretransplant IHAs titre 57 and can also be associated with serious consequences and even fatality. 61,[63][64][65][66] Risk factors for this complication are T-cell depletion and GVHD prophylaxis with cyclosporin A without methotrexate.…”

Section: Peritransplant Strategiesmentioning

confidence: 99%

ABO-incompatible bone marrow transplantation: a GITMO survey of current practice in Italy and comparison with the literature

Raimondi

Soli

Lamparelli

et al. 2004

Bone Marrow Transplant

View full text Add to dashboard Cite

Isoagglutinins following ABO‐Incompatible Bone Marrow Transplantation

Cited by 30 publications

References 11 publications

Delayed donor red cell chimerism and pure red cell aplasia following major ABO-incompatible nonmyeloablative hematopoietic stem cell transplantation

Delayed donor red cell chimerism and pure red cell aplasia following major ABO-incompatible nonmyeloablative hematopoietic stem cell transplantation

Prevention of pure red cell aplasia after major or bidirectional ABO blood group incompatible hematopoietic stem cell transplantation by pretransplant reduction of host anti-donor isoagglutinins

ABO-incompatible bone marrow transplantation: a GITMO survey of current practice in Italy and comparison with the literature

Contact Info

Product

Resources

About