Engraftment of early erythroid progenitors is not delayed after non-myeloablative major ABO-incompatible haematopoietic stem cell transplantation
Autor: | J, Maciej Zaucha, Marco, Mielcarek, Alessandra, Takatu, Marie-Terese, Little, Theodore, Gooley, Jennifer, Baker, David G, Maloney, Brenda M, Sandmaier, Michael, Maris, Thomas, Chauncey, Rainer, Storb, Beverly, Torok-Storb |
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Rok vydání: | 2002 |
Předmět: |
Adult
Erythroid Precursor Cells Transplantation Chimera Transplantation Conditioning Graft Survival Hematopoietic Stem Cell Transplantation Middle Aged Hemolysis ABO Blood-Group System Hemagglutinins Immunoglobulin M Blood Group Incompatibility Child Preschool Immunoglobulin G Humans Transplantation Homologous Child Erythrocyte Transfusion Aged |
Zdroj: | British journal of haematology. 119(3) |
ISSN: | 0007-1048 |
Popis: | We hypothesized that patients undergoing major ABO-incompatible non-myeloablative haematopoietic stem cell transplantation (nm-HSCT) might experience prolonged haemolysis after transplant due to the delayed disappearance of host plasma cells producing anti-donor isohaemagglutinins (HAs). To address this question, we analysed data from 107 consecutive patients transplanted with allogeneic peripheral blood stem cells from human leucocyte antigen-matched (related, n = 84; unrelated, n = 23) donors after non-myeloablative conditioning (200 cGy total body irradiation +/- fludarabine). In total, 23 out of the 107 patients received major or major/minor ABO-incompatible transplants. Red blood cell (RBC) transfusion requirements during the first 120 d post transplant were higher in major ABO-mismatched than in ABO-matched recipients (0.12 vs 0.03 median units RBC concentrate/d, P = 0.04). Two patients developed transient pure red cell aplasia, which had resolved spontaneously by 9 months after transplant. Major ABO incompatibility did not influence rates of engraftment. Patients with sustained engraftment experienced gradual declines of anti-donor HAs, and the estimated median time to reaching IgM and IgG titres of1:1 was at least 133 d in evaluable patients, approximately twice longer than reported after myeloablative conditioning. There was a strong correlation between degrees of donor chimaerism in erythroid burst-forming units, granulocyte macrophage colony-forming units and granulocytes, indicating that donor erythroid engraftment, defined by early erythroid progenitors, was as prompt as myeloid engraftment. In conclusion, our data suggest that major ABO-incompatibility is not a barrier to successful non-myeloablative HSCT. |
Databáze: | OpenAIRE |
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