Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Br J Haematol. 2013 Mar;160(6):798-805. doi: 10.1111/bjh.12210. Epub 2013 Jan 18.
Major ABO mismatching is not considered a contraindication to allogeneic haematopoietic stem cell transplantation (HSCT). Modern reduced-intensity conditioning and reduced-toxicity regimens cause much less myeloablation than conventional myeloablative regimens, such as cyclophosphamide with busulfan or total body irradiation, which may affect the incidence of pure red cell aplasia (PRCA). We estimated the incidence and described the natural history of PRCA in patients with major ABO-mismatched donor stem cells. Between 2007 and 2008, 161 (27% of all patients undergoing HSCT) underwent allogeneic HSCT with major ABO-mismatched stem cells and 12 (7·5%) of these patients developed PRCA. Thirty and ninety day T-cell and myeloid cell chimerism and neutrophil and platelet engraftment did not differ between patients who developed PRCA and those who did not. The only risk factor associated with PRCA was the use of a fludarabine/busulfan conditioning regimen. All patients with PRCA needed red cell transfusion for several months after HSCT resulting in significant iron overload. Pure red cell aplasia resolved spontaneously in the majority (seven patients) but only resolved after stopping tacrolimus in three patients. Hence, after major ABO-mismatched HSCT, the incidence of PRCA was 7·5% and it resolved spontaneously or after withdrawal of immunosuppression in the majority of patients.
主要 ABO 血型不合并不被认为是异基因造血干细胞移植（HSCT）的禁忌。现代的低强度预处理和减毒方案比传统的骨髓清除性预处理方案（如环磷酰胺联合白消安或全身照射）引起的骨髓清除作用小得多，这可能会影响纯红细胞再生障碍（PRCA）的发生率。我们评估了主要 ABO 血型不合供者干细胞移植患者中 PRCA 的发生率并描述了其自然病程。在 2007 年至 2008 年期间，有 161 名（所有接受 HSCT 患者的 27%）接受了主要 ABO 血型不合的干细胞异基因 HSCT，其中 12 名（7.5%）患者发生了 PRCA。发生 PRCA 的患者和未发生 PRCA 的患者之间，30 天和 90 天的 T 细胞和髓样细胞嵌合率、中性粒细胞和血小板植入情况没有差异。与 PRCA 相关的唯一危险因素是使用氟达拉滨/白消安预处理方案。大多数（7 名）PRCA 患者在 HSCT 后需要数月的红细胞输注，导致明显的铁过载。大多数患者（7 名）的纯红细胞再生障碍症会自发缓解，但在 3 名患者中停用他克莫司后才缓解。因此，在主要 ABO 血型不合的 HSCT 后，PRCA 的发生率为 7.5%，大多数患者会自发缓解或在停用免疫抑制剂后缓解。
