Sun Wan-Jun, Guo Mei, Qiao Jian-Hui, Yu Chang-Lin, Wang Dan-Hong, Sun Qi-Yun, Zhang Shi, Li Xin, Ai Hui-Sheng
Department of Hematology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing 100039, China.
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2005 Feb;13(1):39-42.
To explore the effects of ABO incompatibility between recipient and donor on HLA-matched nonmyeloablative allogeneic peripheral blood stem cell transplantation (NAST), a retrospective, cohort study was performed. Among 24 HLA-matched NAST, 15 were major ABO-incompatible and 9 minor. Control group included 24 HLA-matched NAST with ABO-compatible grafts. Nonmyeloablative conditioning regimens consisted of CTX, Ara-C and ATG. The patients were given cyclosporine A and mycophenolate mofetile for prophylaxis of acute GVHD. The ABO-incompatible patients received grafts depleted erythrocytes by hydroxyethyl starch (HES) sedimentation. The results showed that successful and stable engraftment was established in 23 patients. No recipient developed clinically immediate hemolysis during graft infusion, but 2 recipients experienced delayed hemolysis attributable to the ABO incompatibility. The median time of granulocyte counts >0.5 x 10(9)/L and platelet >30 x 10(9)/L was 11 and 14.9 days, respectively. In ABO major incompatible group, the onset of erythropoiesis after NAST was delayed. One out of 10 recipients with blood group "O" in this group developed pure red cell aplasia (PRCA), lasting 5 months. The acute GVHD occurred in 7 out of the 24 patients. The chronic GVHD occurred in 5 of 21 cases. Relapse was observed in 2 patients with acute leukemia. The actuarial probability of disease-free survival at 2 years was 63.3%. In conclusion, ABO-incompatible grafts for NAST have no adverse effect on engraftment, recovery of platelets, incidence of GVHD, relapse rate or survival. ABO-incompatible NAST is fairly safe if there is indication, however, the onset of erythropoiesis is delayed when major ABO mismatched.
为探讨受者与供者之间ABO血型不合对HLA配型的非清髓性异基因外周血干细胞移植（NAST）的影响，进行了一项回顾性队列研究。在24例HLA配型的NAST中，15例为主要ABO血型不合，9例为次要ABO血型不合。对照组包括24例HLA配型且ABO血型相合的NAST。非清髓性预处理方案由环磷酰胺（CTX）、阿糖胞苷（Ara-C）和抗胸腺细胞球蛋白（ATG）组成。患者接受环孢素A和霉酚酸酯预防急性移植物抗宿主病（GVHD）。ABO血型不合的患者接受经羟乙基淀粉（HES）沉降去除红细胞的移植物。结果显示，23例患者实现了成功且稳定的植入。在移植物输注期间，没有受者发生临床即时溶血，但有2例受者出现了归因于ABO血型不合的迟发性溶血。粒细胞计数>0.5×10⁹/L和血小板计数>30×10⁹/L的中位时间分别为11天和14.9天。在主要ABO血型不合组中，NAST后红细胞生成开始延迟。该组中10例血型为“O”的受者中有1例发生了纯红细胞再生障碍（PRCA），持续5个月。24例患者中有7例发生了急性GVHD。21例患者中有5例发生了慢性GVHD。2例急性白血病患者出现复发。2年无病生存的精算概率为63.3%。总之，NAST的ABO血型不合移植物对植入、血小板恢复、GVHD发生率、复发率或生存率没有不良影响。如果有指征，ABO血型不合的NAST相当安全，然而，当主要ABO血型不匹配时，红细胞生成开始延迟。
