Departments of Pediatric Hematology/Oncology, Medizinische Hochschule Hannover, Hannover, Germany.
Transfusion. 2010 Mar;50(3):649-55. doi: 10.1111/j.1537-2995.2009.02461.x. Epub 2009 Nov 19.
Delayed donor red blood cell chimerism (DRCC), pure red blood cell aplasia (PRCA), and autoimmune hemolytic anemia (AIHA) are poorly documented complications after hematopoietic cell transplantation (HCT). The clinical variable "prolonged isolated red blood cell transfusion requirement" (PRTR) was evaluated as a trigger for an extended diagnostic workup.
PRTR was defined as the need for red blood cell (RBC) transfusions beyond Day 60 after HCT. We analyzed 487 patients transplanted between 2000 and 2006. Median age was 37 years (range, 0-70 years). Peripheral blood stem cells (n = 344), marrow (n = 138), and cord blood (n = 5) from 278 unrelated and 209 family donors were used.
Univariate analysis identified age (incidence of 18.3% among elderly patients, 10.5% in adults, and 2.0% among children [p = 0.002]), ABO incompatibility (16.4% after major incompatible, 2.9% after minor incompatible, and 9.4% after ABO-compatible transplantations [p = 0.003]), conditioning (15.2% after reduced-intensity regimens vs. 7.3% after myeloablative conditioning; p = 0.006), donor type (13.2% after HLA-matched unrelated, 13.6% after mismatched unrelated, 5.7% after matched related, and 0.0% after mismatched related grafts; p = 0.026), and acute graft-versus-host disease (aGVHD; 7.1% with aGVHD vs. 12.5% without aGVHD; p = 0.046) as predisposing factors. In multivariate analysis minor ABO incompatibility (odds ratio [OR] = 0.2, p = 0.01), younger age (OR = 0.1, p = 0.02), and matched related HCT (OR = 0.4, p = 0.02) remained independent protective factors.
PRTR could serve as a trigger for a standardized screening for DRCC, PRCA, and AIHA after HCT.
造血细胞移植（HCT）后发生迟发性供者红细胞嵌合体（DRCC）、纯红细胞再生障碍性贫血（PRCA）和自身免疫性溶血性贫血（AIHA）是少见的并发症。我们将“需要长期单独输注红细胞（RBC）”这一临床变量定义为触发广泛诊断检查的指征。
PRTR 定义为 HCT 后第 60 天仍需输注 RBC。我们分析了 2000 年至 2006 年间接受移植的 487 例患者。中位年龄为 37 岁（0-70 岁）。使用了 278 例无关供者和 209 例亲缘供者的外周血干细胞（n = 344）、骨髓（n = 138）和脐带血（n = 5）。
单因素分析发现年龄（老年患者为 18.3%，成年患者为 10.5%，儿童为 2.0%，p = 0.002）、ABO 不相容（主要不相容为 16.4%，次要不相容为 2.9%，ABO 相容为 9.4%，p = 0.003）、预处理方案（强度降低为 15.2%，清髓性为 7.3%，p = 0.006）、供者类型（HLA 匹配的无关供者为 13.2%，不匹配的无关供者为 13.6%，匹配的亲缘供者为 5.7%，不匹配的亲缘供者为 0.0%，p = 0.026）和急性移植物抗宿主病（aGVHD；aGVHD 为 7.1%，无 aGVHD 为 12.5%，p = 0.046）是导致 DRCC、PRCA 和 AIHA 的危险因素。多因素分析显示，次要 ABO 不相容（比值比 [OR] = 0.2，p = 0.01）、年龄较小（OR = 0.1，p = 0.02）和匹配的亲缘供者 HCT（OR = 0.4，p = 0.02）是独立的保护因素。
PRTR 可作为 HCT 后筛查 DRCC、PRCA 和 AIHA 的一个触发因素。
