在减低预处理强度后的次要不匹配ABO血型的异基因外周血祖细胞移植中，进行预防性红细胞置换以预防严重免疫性溶血。

Prophylactic red blood cell exchange for prevention of severe immune hemolysis in minor ABO-mismatched allogeneic peripheral blood progenitor cell transplantation after reduced-intensity conditioning.

作者信息

Worel Nina, Greinix Hildegard T, Supper Volker, Leitner Gerda, Mitterbauer Margit, Rabitsch Werner, Fischer Gottfried, Rosenmayr Agathe, Höcker Paul, Kalhs Peter

机构信息

Department for Blood Group Serology and Transfusion Medicine, First Medical Department, Bone Marrow Transplantation, Medical University of Vienna, Wāhringer Gürtel 18-20, A-1090 Vienna, Austria.

出版信息

Transfusion. 2007 Aug;47(8):1494-502. doi: 10.1111/j.1537-2995.2007.01289.x.

DOI:10.1111/j.1537-2995.2007.01289.x

PMID:17655594

Abstract

BACKGROUND

Delayed severe immune hemolysis due to donor-derived passenger lymphocytes is observed in minor and/or bidirectional ABO-mismatched transplants, especially after reduced-intensity conditioning (RIC). The incidence is reported in up to 30 percent of patients and can result in multiorgan failure (MOF) and death.

STUDY DESIGN AND METHODS

A first group of 32 patients (historical control) underwent RIC followed by allogeneic hematopoietic peripheral blood progenitor cell transplantation at our institution. In 5 of 10 patients with a minor and/or bidirectional ABO-mismatched graft, severe immune hemolysis was observed, leading to death in 3 of them. Therefore, we initiated a protocol with prophylactic red blood cell (RBC) exchange in minor and/or bidirectional ABO mismatch of a second group of patients (study group) and investigated the incidence of hemolysis, transplant-related mortality (TRM), and overall survival (OS) and compared these data with the historical control group. Twenty-two of 80 patients in the study group had a minor and/or bidirectional ABO-mismatched donor.

RESULTS

In 20 patients, a prophylactic RBC exchange was performed. Three patients showed mild to moderate citrate reactions, and in 1 patient the procedure had to be stopped because of hypotension. Eighteen of 20 patients engrafted uneventfully, 1 patient rejected his graft, and another 1 showed signs of mild hemolysis. In the minor and/or bidirectional ABO-mismatched setting patients in the study group had a lower risk for TRM at 1 year compared to patients in the historical control group (16% vs. 53%, p < 0.05) and a better 1-year OS (65% vs. 40%, p < 0.05).

CONCLUSION

RBC exchange is a safe procedure, reducing the incidence of delayed severe immune hemolysis and thus the risk of TRM in minor and/or bidirectional ABO-mismatched cases.

摘要

背景

在次要和/或双向ABO血型不匹配的移植中，尤其是在减低强度预处理（RIC）后，会观察到供体来源的过客淋巴细胞导致的延迟性严重免疫性溶血。据报道，高达30%的患者会出现这种情况，并且可能导致多器官功能衰竭（MOF）和死亡。

研究设计与方法

第一组32例患者（历史对照组）在我们机构接受了RIC，随后进行了异基因造血外周血祖细胞移植。在10例次要和/或双向ABO血型不匹配移植的患者中，有5例出现了严重免疫性溶血，其中3例死亡。因此，我们启动了一项方案，对第二组患者（研究组）在次要和/或双向ABO血型不匹配时进行预防性红细胞（RBC）置换，并调查溶血发生率、移植相关死亡率（TRM）和总生存率（OS），并将这些数据与历史对照组进行比较。研究组80例患者中有22例供体为次要和/或双向ABO血型不匹配。

结果

20例患者进行了预防性RBC置换。3例患者出现轻度至中度枸橼酸盐反应，1例患者因低血压不得不停止该操作。20例患者中有18例顺利植入，1例患者移植失败，另1例出现轻度溶血迹象。在次要和/或双向ABO血型不匹配的情况下，研究组患者1年时的TRM风险低于历史对照组患者（16%对53%，p<0.05），1年总生存率更高（65%对40%，p<0.05）。