Vanderbilt University Medical Center, Department of Pathology, Microbiology and Immunology, Division of Transfusion Medicine, USA; University of Virginia Health System, Department of Pathology, Charlottesville, VA, USA.
Vanderbilt University Medical Center, Department of Pathology, Microbiology and Immunology, Division of Transfusion Medicine, USA; Vanderbilt University Medical Center, Department of Pediatrics, Division of Hematology/Oncology, USA.
Transfus Apher Sci. 2021 Feb;60(1):102965. doi: 10.1016/j.transci.2020.102965. Epub 2020 Oct 19.
Isohemagglutinins occur naturally and form in an 'opposite' (antigen-negative) pattern to a patient's ABO blood type. Patients undergoing minor and bidirectional ABO incompatible hematopoietic stem cell transplantation (HSCT) may demonstrate detectable antibodies against their native blood type. In this study, we sought to characterize the rates of such antibody formation and evaluate the clinical significance of our findings.
An internal database of HSCT patients at an academic medical center was queried for ABO incompatible transplant patients from 2009-2019. Serum typing results, clinical histories, and laboratory data were compiled and reviewed.
A total of 182 minor and bidirectional ABO incompatible HSCT patients were identified. Anti-recipient isohemagglutinins were found in 9% (16/182) of the HSCT patients. The rate was higher in patients with minor incompatibility (12%: 15/127) versus bidirectional ABO incompatibility (2%: 1/55) (p = 0.04). No anti-recipient isohemagglutinins were identified in umbilical cord HSCT patients (0%: 0/7). Serologic agglutination reactions of recipient isohemagglutinins were overall mostly weak (13/16 weak + to 1+). There was a trend towards a higher rate of acute graft-versus-host-disease in patients with anti-recipient isohemagglutinins compared to those without (75% vs. 53%; p = 0.12), though not statistically significant. Rates of alloimmunization to minor red cell antigens were similar between the two groups. Few patients showed laboratory evidence of hemolysis at 12 months follow up.
Anti-recipient isohemagglutinins occur at low rates in ABO incompatible HSCT and are significantly more common in minor ABO incompatible transplant compared to bidirectional transplants. Larger cohort studies are needed to better understand the relationship between anti-recipient isohemagglutinins and HSCT outcomes.
天然存在同种异型凝集素，其形成模式与患者的 ABO 血型呈“相反”（抗原阴性）。接受小范围和双向 ABO 不相容造血干细胞移植（HSCT）的患者可能会表现出针对其天然血型的可检测抗体。在这项研究中，我们试图描述这种抗体形成的比率，并评估我们发现的临床意义。
对学术医疗中心的 HSCT 患者的内部数据库进行了查询，以确定 2009 年至 2019 年期间的 ABO 不相容移植患者。收集并回顾了血清分型结果、临床病史和实验室数据。
共确定了 182 例小范围和双向 ABO 不相容 HSCT 患者。在 9%（16/182）的 HSCT 患者中发现了抗受者同种异型凝集素。在小范围不相容患者中（12%：15/127）的发生率高于双向 ABO 不相容患者（2%：1/55）（p=0.04）。在脐带血 HSCT 患者中未发现抗受者同种异型凝集素（0%：0/7）。受者同种异型凝集素的血清学凝集反应总体上大多较弱（13/16 为弱+至 1+）。与无抗受者同种异型凝集素的患者相比，有抗受者同种异型凝集素的患者急性移植物抗宿主病的发生率更高（75%比 53%；p=0.12），但无统计学意义。两组患者对次要红细胞抗原的同种免疫率相似。少数患者在 12 个月随访时出现实验室证据表明有溶血。
在 ABO 不相容 HSCT 中，抗受者同种异型凝集素的发生率较低，在小范围 ABO 不相容移植中明显高于双向移植。需要更大的队列研究来更好地了解抗受者同种异型凝集素与 HSCT 结果之间的关系。
