ABO mismatch may affect engraftment in multiple myeloma patients receiving nonmyeloablative conditioning

Autor: Ashraf Badros, Michele Cottler-Fox, Nikhil C. Munshi, Amir A. Toor, Chuanfa Guo, Christopher Morris, Bart Barlogie, Guido J Tricot
Rok vydání: 2002
Předmět:
Adult
Graft Rejection
Male
congenital
hereditary
and neonatal diseases and abnormalities
medicine.medical_specialty
Transplantation Conditioning
Lymphocyte
Immunology
Graft vs Host Disease
Red-Cell Aplasia
Pure
Gastroenterology
ABO Blood-Group System
hemic and lymphatic diseases
ABO blood group system
Immunopathology
Internal medicine
parasitic diseases
Humans
Transplantation
Homologous
Immunology and Allergy
Medicine
Prospective cohort study
Multiple myeloma
Aged
Bone Marrow Transplantation
Transplantation Chimera
business.industry
Graft Survival
Hematology
Aplasia
Middle Aged
medicine.disease
Tissue Donors
biological factors
Surgery
Transplantation
Treatment Outcome
surgical procedures
operative
medicine.anatomical_structure
Blood Group Incompatibility
Female
Bone marrow
Erythrocyte Transfusion
Multiple Myeloma
business
Zdroj: Transfusion. 42:205-209
ISSN: 1537-2995
0041-1132
DOI: 10.1046/j.1537-2995.2002.00027.x
Popis: BACKGROUND: Blood group incompatibility does not appear to affect the overall outcome in patients undergoing myeloablative conditioning before allogeneic BMT. Data on ABO-mismatched transplantation in the nonmyeloablative setting are limited. STUDY DESIGN AND METHODS: A retrospective analysis of the effects of ABO mismatches in multiple myeloma patients who received a nonmyeloablative conditioning regimen was conducted. RESULTS: Three of 27 patients received a minor ABO-mismatched graft, all with evidence of hemolysis before converting to donor ABO group on Days 10, 15, and 6. Six patients received a major ABO-mismatched graft; of these, three developed GVHD of more than grade 2 and subsequently converted to the ABO blood group of the donor on Days 38, 33, and 43. Of the three patients without GVHD, one rejected the allograft and had autologous reconstitution. One remained a mixed chimera to Day 100 despite three donor lymphocyte infusions, and one developed pure RBC aplasia. None of the ABO-matched patients rejected the graft, whether they developed GVHD or not. RBC transfusions were significantly higher in the major and minor ABO-mismatched patients than in the ABO-matched patients, with medians of 12 units (range, 2-35), 13 units (range, 5-18), and 4 units (range, 2-15), respectively (p = 0.02). ABO-matched patients had a similar incidence of GVHD, with 5 of 9 ABO-mismatched patients (56%) having more than grade 2 versus 10 of 18 (56%). Four of 9 ABO-mismatched patients (44%) were mixed chimeras up to Day 100 versus 2 of 18 ABO-matched patients (11%), and the difference was significant (p = 0.01). CONCLUSION: Patients with ABO mismatch had problems with engraftment, including graft rejection, pure RBC aplasia, and mixed-lineage chimerism. RBC transfusions were significantly higher in the ABO-mismatched recipients. GVHD may play a role in engraftment, possibly by facilitating the disappearance of native ABO antibodies via graft-versus-plasma cell effect. A prospective study to evaluate the effects of ABO mismatch on engraftment in the nonmyeloablative setting is needed.
Databáze: OpenAIRE
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