Prevalence of Pure Red Cell Aplasia Following Major ABO-Incompatible Hematopoietic Stem Cell Transplantation

Abstract

BackgroundPure red cell aplasia (PRCA) is one of the important complications in major ABO-incompatible allogeneic hematopoietic stem cell transplantation (HSCT). The established pathogenic factor of PRCA is the persistence of high anti-donor isohemagglutinins. As previously verified, the conditioning regimen and donor type were the factors associated with the development of PRCA in the small-sized studies. Currently, the prevalence, risk factors, and prognosis of PRCA are still worth studying to provide evidence.MethodsWe conducted a prospective nested case-control study to determine the prevalence, donor-related factors, and the outcomes of PRCA following major ABO-incompatible transplantation. A total of 469 patients who underwent ABO-incompatible grafts were observed.ResultsNone of the patients were diagnosed with PRCA with minor or bidirectional ABO-incompatible HSCT. Thirteen of the187 patients (7%; 95% confidence interval [CI], 3.9%–11.9%) developed PRCA following major ABO-incompatible HSCT. Eleven of the 13 patients with PRCA recovered entirely. Donor type was an independent factor associated with post-HSCT PRCA (odds ratio [OR]=0.030; 95% CI, 0.003–0.321; P=0.004). The cumulative incidence rates of post-HSCT PRCA in the context of major ABO-incompatible HSCT were 0.8%, 13.1%, and 27.2% for the haploidentical donor (HID), unrelated donor, and matched related donor, respectively. No significant influence of PRCA on transplantation outcomes was observed.In conclusion, post-HSCT PRCA is a rare and less threatening complication in major ABO-incompatible HSCT. The majority of patients with PRCA could recover. Additionally, HIDs for recipients may have a low risk of post-HSCT PRCA. This trial was registered at www.chictr.org.cn (#ChiCTR2000041412).

Impact of myelofibrosis on patients with myelodysplastic syndromes following allogeneic hematopoietic stem cell transplantation

“…As previously described, conditioning regimens incorporated myeloablative conditioning (MAC) comprising busulfan and cyclophosphamide and reduced-intensity conditioning (RIC) comprising fludarabine and busulfan [ 18 , 19 ]. Graft-versus-host disease (GVHD) prophylaxis comprised cyclosporin A, methotrexate, and low dose mycophenolate mofetil.…”

Immuno-Hematologic Complexity of ABO-Incompatible Allogeneic HSC Transplantation

“…The incidence of PRCA after major ABO incompatibility HSCT ranges from 7% to 30% and shows severe normocytic anemia and reticulocytopenia, and the lack of erythroblasts from otherwise normal bone marrow persists for more than 30 days post HSCT, in the absence of leukemia relapse, drug toxicity, or infection. A persistence of anti-donor IHAs due to recipient-derived plasma cells and a titer higher than 1:64 is an indicator of PRCA [33].…”

Immuno-Hematologic Complexity of ABO-Incompatible Allogeneic HSC Transplantation

“…The incidence of PRCA after major ABO incompatibility HSCT ranges from 7% to 30% and shows severe normocytic anemia, reticulocytopenia, and an absence of erythroblasts from otherwise normal bone marrow occurred for more than 30 days post-HSCT, in the absence of leukemia relapse, drug toxicity, or infection. The persistence of anti-donor isohemoagglutinins due to recipient-derived plasma cells and the titer more than 1:64 is an indicator of PRCA [33]. The risk factors for PRCA (30-120 days post-HSCT) may include recipients with type A anti-donor IHAs, the nonmyeloablative conditioning regimen or the use of a fludarabine/busulfan conditioning regimen, and unrelated donors or HLA-matched related donors (compared to haploidentical donors) [5].…”