Stussi Georg, Halter Jörg, Bucheli Eveline, Valli Piero V, Seebach Lutz, Gmür Jürg, Gratwohl Alois, Schanz Urs, Passweg Jakob R, Seebach Jörg D
Clinic for Hematology and Laboratory for Transplantation Immunology, Department of Internal Medicine, University Hospital, Zürich, Switzerland.
Haematologica. 2009 Feb;94(2):239-48. doi: 10.3324/haematol.13356. Epub 2009 Jan 14.
Persistent anti-donor isoagglutinins after major ABO blood group incompatible hematopoietic stem cell transplantation may cause delayed red blood cell engraftment and post-transplant pure red cell aplasia.
We investigated the effect of pretransplant anti-donor isoagglutinin reduction by in vivo absorption and/or plasmapheresis on the incidence of pure red cell aplasia and the time to red blood cell engraftment in 153 hematopoietic stem cell transplant recipients with major ABO incompatibility.
Twelve patients (8%) developed pure red cell aplasia, 3/98 (3%) with, and 9/55 (16%) without prior isoagglutinin reduction (p=0.009). Red blood cell engraftment was faster in patients with isoagglutinin reduction; in addition, peripheral blood hematopoietic stem cell transplantation, acute graft-versus-host disease, and younger age were associated with faster red blood cell engraftment in Cox regression analysis. In patients with pure red cell aplasia the mean red blood cell engraftment occurred after 225 days (p<0.001) and was associated with a simultaneous decrease of anti-donor isoagglutinins. Patients with pure red cell aplasia had higher pretransplant anti-donor isoagglutinin titers (p=0.001) and received more post-transplant red blood cell transfusions (p<0.001).
Following major ABO incompatible hematopoietic stem cell transplantation, pure red cell aplasia and delayed red blood cell engraftment depend on the levels of anti-donor isoagglutinins and are efficiently prevented by the pretransplant removal of these isoagglutinins. The benefits of reducing the time of transfusion-dependency and transfusion-associated risks must be carefully balanced against the potential side effects of isoagglutinin reduction.
主要ABO血型不合的造血干细胞移植后持续存在的抗供体同种凝集素可能导致红细胞植入延迟和移植后纯红细胞再生障碍。
我们研究了通过体内吸附和/或血浆置换降低移植前抗供体同种凝集素对153例主要ABO血型不合的造血干细胞移植受者纯红细胞再生障碍发生率和红细胞植入时间的影响。
12例患者（8%）发生纯红细胞再生障碍，98例中有3例（3%）在降低同种凝集素之前发生，55例中有9例（16%）未降低同种凝集素（p=0.009）。降低同种凝集素的患者红细胞植入更快；此外，在Cox回归分析中，外周血造血干细胞移植、急性移植物抗宿主病和年轻与红细胞植入更快相关。发生纯红细胞再生障碍的患者平均红细胞植入在225天后出现（p<0.001），并且与抗供体同种凝集素同时降低有关。发生纯红细胞再生障碍的患者移植前抗供体同种凝集素滴度更高（p=0.001），并且接受了更多的移植后红细胞输血（p<0.001）。
在主要ABO血型不合的造血干细胞移植后，纯红细胞再生障碍和红细胞植入延迟取决于抗供体同种凝集素的水平，并且通过移植前去除这些同种凝集素可有效预防。减少输血依赖时间和输血相关风险的益处必须与降低同种凝集素的潜在副作用仔细权衡。
