Selective ABO immunoadsorption in hematopoietic stem cell transplantation with major ABO incompatibility

Abstract

Objective ABO mismatch between donor and recipient occurs in 40% of allogeneic hematopoietic stem cell transplantations (HCT). Different strategies have been described to reduce isohemagglutinins (IHA) before HCT. We describe the effect of selective ABO immunoadsorption (ABO IA) on erythrocyte transfusion rate and the development of post‐transplant pure red cell aplasia (ptPRCA). Methods 63 patients with major ABO incompatibility were retrospectively analyzed. Nine patients with major ABO incompatibility and high‐IHA titer were treated by ABO IA before HCT. We analyzed the need for transfusion and the occurrence of ptPRCA. We compared the outcome with patients treated by other methods to reduce IHA. Results In all nine patients treated by ABO IA, IHA decreased in a median four times. PtPRCA occurred in one patient. The median number of transfusions was 8 (range: 0‐36) between d0 and d100. In 25 patients with high‐IHA titer without treatment or treated by other methods to reduce IHA, the need for transfusions was comparable. No difference in the incidence of ptPRCA was observed. Conclusions Selective ABO IA is a feasible, safe, and effective method to reduce IHA before HCT in major ABO incompatibility. No effect on transfusion rate or ptPRCA compared to other strategies could be observed.

Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Ninth Special Issue

“…In some European centers, isohemagglutinin titer reduction may be accomplished by slowly infusing donor-type RBCs to adsorb antibodies in vivo. Selective ABO immunoadsorption has also been reported, though without clear differences in clinical outcomes (Crysandt, 2021). Posttransplant PRCA in the setting of major ABO incompatibility usually recovers with early withdrawal of immunosuppression (cyclosporine) and supportive transfusion.…”

Pure red cell aplasia among ABO mismatched hematopoietic stem cell transplant recipients: a 13-years retrospective study and literature review

“…The realm of apheresis therapy presents various procedures, including IA and PEX, designed to eliminate anti-donor IHA. Some authors advocate for IHA reduction through PEX as a preemptive measure before HSCT to prevent the occurrence of PRCA ( 28 , 29 ). Four patients exclusively subjected to IA using Glycosorb ® and an additional two individuals treated with a sequential regimen of IA Glycosorb ® followed by PEX and prednisone, on day +159, demonstrated a significant reduction in IHA titer and transfusion independence, achieved within a mean duration of 28.5 days ( 24 ).…”

Association of ABO mismatch with the outcomes of allogeneic hematopoietic cell transplantation for acute leukemia

“…Several prior studies have evaluated the effect of ABO mismatch in allo‐HCT, but their conflicting results have added complexity to understand its independent impact on outcomes 3–10 . Hence, allo‐HCT is often performed across ABO mismatches and transplant centers utilize a variety of approaches to mitigate its impact pre‐ and/or post‐transplant 11,12 . One important limitation to the prior studies is the heterogeneity of the disease types included.…”

“…[3][4][5][6][7][8][9][10] Hence, allo-HCT is often performed across ABO mismatches and transplant centers utilize a variety of approaches to mitigate its impact pre-and/or posttransplant. 11,12 One important limitation to the prior studies is the heterogeneity of the disease types included. For example, most studies with large sample size have included a mix of underlying disorders including malignant and non-malignant conditions.…”