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Estrina et al. (Abstract)

Cellular Therapy and Transplantation (CTT), Vol. 3, No. 9
doi: 10.3205/ctt-2010-No9-abstract22
© The Authors. This abstract is provided under the following license: Creative Commons Attribution 3.0 Unported

Abstract accepted for "4th Raisa Gorbacheva Memorial Meeting on Hematopoietic Stem Cell Transplantation",
Saint Petersburg, Russia, September 18–20, 2010

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The probability of acute graft-versus-host disease depending on the group of patients with ABO- incompatibility after allogeneic hematopoietic stem cell transplantation

Maria A. Estrina, Evgenia A. Kochina, Natalia E. Ivanova, Aleksandr L. Alyansky, Abdulbasir A. Ganapiev, Boris V. Afanasyev

R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, Pavlov State Medical University, Saint-Petersburg, Russia

Correspondence: Maria A. Estrina, R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, Saint-Petersburg Pavlov State Medical University, 6/8, Tolstoy str., Saint-Petersburg, 197022, Russia, E-mail: estrina.ma@spam is badmail.ru

Abstract

Introduction: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is currently one of the most effective methods of treatment for various malignant hematological disorders. Recently, the ABO system antigens’ incompatibility between donor and recipient has been given much emphasis as an important risk factor able to influence allo-HSCT recipient’s post-transplant course.

Materials and methods: Two hundred and forty allo-HSCT recipients were included in this study, 69 (29%) patients were transplanted from matched related donors, and 171 (71%) patients from matched unrelated donors. One hundred and forty six (61%) donor-recipient pairs were ABO mismatched, including major, minor, and bidirectional mismatch in 54 (37%), 67 (46%), and 25 (17%) cases respectively. Peripheral blood stem cells (PBSC) and bone marrow (BM) were used in 148 and 92 cases respectively. The graft-versus-host disease (GVHD) prophylaxis regimen was identical in all patient groups.

Results: We observed no cases of acute hemolysis after PBSC transfusion, but 2 cases of serious hemolysis (0.8%) developed in the BM recipient group. There were no significant differences in engraftment kinetics in ABO-compatible and ABO-incompatible patient groups (р=0.6) and between patient groups with different forms of ABO-incompatibility (р=0.38).

Pure red cell aplasia was observed in 2 patients with major ABO-incompatibility.
Acute GVHD was more frequent after ABO-mismatched than ABO-matched allo-HSCT (44% vs 21%, р=0,003). The onset of severe aGVHD (Grade III–IV) was also significantly higher after ABO-mismatched allo-HSCT (23% versus 6% after ABO-matched alloHSCT, p=0.001). 

After ABO-mismatched MUD allo-HSCT, severe aGVHD (Grade III–IV) was seen in 47 of 166 pts (28%), whereas after ABO-matched MUD allo-HSCT acute GVHD developed in 12 of 166 pts (p=0.003). After ABO-matched MRD allo-HSCT severe aGVHD (Grade III–IV) was seen in only 2 of 63 pts (3%) and in 5 of 63 pts (8%) after ABO-mismatched MRD allo-HSCT (p=0.11).

There was no significant difference in aGVHD development and severity depending on the type of ABO-mismatch. Acute GVHD was noted in minor ABO-mismatches in 42 of 135 pts (31/1%), in 35 of 135 pts (25.9%) with major ABO-mismatches, and in 20 of 135 pts (14.8%) with bidirectional ABO-mismatches. Severe aGVHD (Grade III–IV) was seen after minor, major, and bidirectional ABO-mismatches in 23 of 135 pts (17.1%), 18 of 135 pts (13.5%), and 13 of 135 pts (9.6%) respectively.

Conclusions: ABO incompatibility between donor and recipient can cause acute and delayed hemolysis. It has no influence on leukocyte, neutrophil, or platelet engraftment, but could lead to pure red cell aplasia.

The АВО-incompatibility is an important risk factor for acute GVHD development and severity.

Keywords: allo-HSCT, АВО-incompatibility, acute GVHD

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