<scp>ABO</scp> blood group antigen mismatch has an impact on outcome after allogeneic peripheral blood stem cell transplantation

Grube, Matthias; Wolff, Daniel; Ahrens, Norbert; Herzberg, Philipp Yorck; Herr, Wolfgang; Holler, Ernst

doi:10.1111/ctr.12840

Cited by 13 publications

(10 citation statements)

References 71 publications

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“…While most TA-TMA is mediated by complement, rare patients can instead have a process driven by autoantibodies, typically to Complement Factor H (CFH), a negative regulator of the alternative pathway (31). It is also thought that other recipient-specific autoantibodies against class II HLA-molecules or other endothelial proteins may be involved (13, 32). One potential clue to this rare occurrence may be a sudden rise in B cell numbers on lymphocyte phenotyping or other autoimmune manifestations.…”

Section: Investigations At First Clinical Suspicion Of Ta-tmamentioning

confidence: 99%

“…Blood group A and B antigens are expressed on endothelial cells and may serve as targets of attack in the setting of HCT from minor ABO-mismatched donors. Many reports suggest that minor ABO mismatch is a risk factor for TRM (32, 42), and this may at least partially driven by increased TA-TMA (40, 43, 44). The use of ABO-incompatible platelets was noted to be a risk factor for the development of SOS (45) though to date this question has not been carefully studied in TMA.…”

Section: Risk Factorsmentioning

confidence: 99%

See 1 more Smart Citation

Transplant-Associated Thrombotic Microangiopathy in Pediatric Hematopoietic Cell Transplant Recipients: A Practical Approach to Diagnosis and Management

2019

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Transplant-associated thrombotic microangiopathy (TA-TMA) is an endothelial damage syndrome that is increasingly identified as a complication of both autologous and allogeneic hematopoietic cell transplantation (HCT) in children. If not promptly diagnosed and treated, TA-TMA can lead to significant morbidity (e.g., permanent renal injury) or mortality. However, as the recognition of the early stages of TA-TMA may be difficult, we propose a TA-TMA “triad” of hypertension, thrombocytopenia (or platelet transfusion refractoriness), and elevated lactate dehydrogenase (LDH). While not diagnostic, this triad should prompt further evaluation for TA-TMA. There is increased understanding of the risk factors for the development of TA-TMA, including those which are inherent (e.g., race, genetics), transplant approach-related (e.g., second HCT, use of HLA-mismatched donors), and related to post-transplant events (e.g., receipt of calcineurin inhibitors, development of graft-vs. -host-disease, or certain infections). This understanding should lead to enhanced screening for TA-TMA signs and symptoms in high-risk patients. The pathophysiology of TA-TMA is complex, resulting from a cycle of activation of endothelial cells to produce a pro-coagulant state, along with activation of antigen-presenting cells and lymphocytes, as well as activation of the complement cascade and microthrombi formation. This has led to the formulation of a “Three-Hit Hypothesis” in which patients with either an underlying predisposition to complement activation or pre-existing endothelial injury (Hit 1) undergo a toxic conditioning regimen causing endothelial injury (Hit 2), and then additional insults are triggered by medications, alloreactivity, infections, and/or antibodies (Hit 3). Understanding this cycle of injury permits the development of a specific TA-TMA treatment algorithm designed to treat both the triggers and the drivers of the endothelial injury. Finally, several intriguing approaches to TA-TMA prophylaxis have been identified. Future work on the development of a single diagnostic test with high specificity and sensitivity, and the development of a robust risk-scoring system, will further improve the management of this serious post-transplant complication.

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Section: Investigations At First Clinical Suspicion Of Ta-tmamentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

Transplant-Associated Thrombotic Microangiopathy in Pediatric Hematopoietic Cell Transplant Recipients: A Practical Approach to Diagnosis and Management

2019

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“…Several studies showed an association between sex mismatch and viral reactivations [9] or the occurrence of GvHD, especially in the combination of a female multiparous donor and a male recipient [10]. Also, some authors suggest a higher risk of infections for ABO blood group antigen incompatible allo-HSCT [11].…”

Section: Introductionmentioning

confidence: 99%

Viral reactivations following hematopoietic stem cell transplantation in pediatric patients – A single center 11-year analysis

et al. 2020

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Viral reactivation occurs frequently in the context of immunodeficiency and immunosuppression after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and can cause severe complications. The aim of this single-center retrospective analysis was to characterize viral infections in the first year after HSCT, to investigate risk factors and to study the impact of viral infections on transplantation outcome. This will facilitate the identification of at-risk patients and the development of new preventive strategies. 107 pediatric allo-HSCT from January 2005 through December 2015 were analyzed for infections with Epstein-Barr virus (EBV), cytomegalovirus (CMV), human herpesvirus 6 (HHV-6), adenovirus (ADV), herpes simplex virus (HSV) and varicella zoster virus (VZV). Viral infections were detected after 68.2% of transplantations. The viruses most commonly encountered were HHV-6 (36/ 107) and EBV (30/107). Severe viral disease was rare (7/107) and none of the patients died as result of viral reactivation. Important risk factors for viral infections were higher age at HSCT, donor type and occurrence of acute graft-versus-host disease (aGvHD). Especially for EBV, transplant from an unrelated donor and in-vivo T-cell depletion (TCD) had a significant effect on infection rates, whereas for CMV the strongest effect was seen by donor and recipient serostatus with recipient seropositivity most predictive for reactivation. The occurrence of severe aGvHD was associated with EBV and ADV infections. For HSV, the recipient serostatus was identified as prognostic factor for HSV infections, while we found higher age at time of HSCT as risk factor for VZV infections. The overall survival of patients with or without viral infections did not differ significantly. Interestingly, when looking at the 85 patients in our cohort who had received an HSCT for a malignant disease, a tendency towards lower relapse rates was seen in patients affected by viral infections (HR 0.51, 95% CI 0.25-1.06, p = 0.072). Viral reactivations are common after pediatric allo-HSCT, though severe complications were rare in our collective. Determining risk factors for viral reactivations may help to identify patients in need of intensified monitoring and to individualize preventive strategies.

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“…Grube et al showed that ABO blood group mismatch has a significant impact on the outcome. Moreover, they found that minor-A and minor-AB ABO-mismatch represent a risk factor for increased transplant-related mortality after allo PBSCT 46 . Bolan in a study showed that hemolysis due to minor mismatched HSCT can be life-threatening and difficult to diagnose.…”

Section: Discussionmentioning

confidence: 99%

ABO Blood Grouping Mismatch in Hematopoietic Stem Cell Transplantation and Clinical Guides

Shokrgozar

Tamaddon

2018

IJHOSCR

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Hematopoietic stem cell transplantation (HSCT) is a useful treatment. In contrast to solid organ transplantations, the use of ABO blood group mismatch is acceptable in HSCT. Immediate or late hemolytic reactions, pure red cell aplasia, delayed red blood cell recovery, and graft-versus -host disease are the results of this situation. This review shows the consequences of ABO-mismatched HSCT and its impacts on HSCT parameters, as well as providing clinical guides in this situation.

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ABO blood group antigen mismatch has an impact on outcome after allogeneic peripheral blood stem cell transplantation

Cited by 13 publications

References 71 publications

Transplant-Associated Thrombotic Microangiopathy in Pediatric Hematopoietic Cell Transplant Recipients: A Practical Approach to Diagnosis and Management

Transplant-Associated Thrombotic Microangiopathy in Pediatric Hematopoietic Cell Transplant Recipients: A Practical Approach to Diagnosis and Management

Viral reactivations following hematopoietic stem cell transplantation in pediatric patients – A single center 11-year analysis

ABO Blood Grouping Mismatch in Hematopoietic Stem Cell Transplantation and Clinical Guides

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