Badros Ashraf, Tricot Guido, Toor Amir, Morris Christopher, Guo Chuanfa, Munshi Nikhil, Barlogie Bart, Cottler-Fox Michele
Myeloma and Transplantation Research Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Transfusion. 2002 Feb;42(2):205-9. doi: 10.1046/j.1537-2995.2002.00027.x.
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.
A retrospective analysis of the effects of ABO mismatches in multiple myeloma patients who received a nonmyeloablative conditioning regimen was conducted.
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).
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.
血型不合似乎并不影响接受异基因骨髓移植前清髓预处理患者的总体预后。关于非清髓预处理情况下ABO血型不相合移植的数据有限。
对接受非清髓预处理方案的多发性骨髓瘤患者中ABO血型不相合的影响进行回顾性分析。
27例患者中有3例接受了轻微ABO血型不相合的移植物，所有患者在第10、15和6天转换为供者ABO血型前均有溶血证据。6例患者接受了主要ABO血型不相合的移植物；其中3例发生了2级以上的移植物抗宿主病（GVHD），随后分别在第38、33和43天转换为供者的ABO血型。在3例未发生GVHD的患者中，1例排斥了同种异体移植物并实现了自体造血重建。1例患者尽管接受了3次供者淋巴细胞输注，但到第100天时仍为混合嵌合体，另1例发生了纯红细胞再生障碍。无论是否发生GVHD，ABO血型相合的患者均未排斥移植物。主要和轻微ABO血型不相合患者的红细胞输注量显著高于ABO血型相合患者，中位数分别为12单位（范围2 - 35）、13单位（范围5 - 18）和4单位（范围2 - 15）（p = 0.02）。ABO血型相合患者的GVHD发生率相似，9例ABO血型不相合患者中有5例（56%）发生了2级以上GVHD，而18例中有10例（56%）。9例ABO血型不相合患者中有4例（44%）到第100天时为混合嵌合体，而18例ABO血型相合患者中有2例（11%），差异有统计学意义（p = 0.01）。
ABO血型不相合的患者存在植入问题，包括移植物排斥、纯红细胞再生障碍和混合谱系嵌合。ABO血型不相合的受者红细胞输注量显著更高。GVHD可能在植入过程中起作用，可能是通过移植物抗浆细胞效应促进天然ABO抗体的消失。需要进行一项前瞻性研究来评估非清髓预处理情况下ABO血型不相合对植入的影响。
