Division of Blood Transfusion, Shinshu University Hospital, Matsumoto, Japan.
Center for Advanced Cell Therapy, Shinshu University Hospital, Matsumoto, Japan.
Clin Transplant. 2021 Jun;35(6):e14300. doi: 10.1111/ctr.14300. Epub 2021 May 12.
ABO-incompatible hematopoietic stem cell transplantations (HSCTs) are widely practiced; however, the delay in erythrocyte engraftment can be problematic. While erythrocyte engraftment is usually indicated by an increase in reticulocyte levels without the need for erythrocyte transfusions, the disappearance of recipient-derived anti-A/B isoagglutinin and detection of donor-derived A/B antigens can also be used as other parameters. We conducted a retrospective analysis of 68 ABO-incompatible HSCTs, focusing on major and bidirectional mismatch. We analyzed known clinical risk factors associated with delayed erythrocyte engraftment using the three parameters (disappearance of anti-A/B isoagglutinin in recipient, detection of donor-derived A/B antigen, and reticulocyte levels >1%). Although the three parameters were well correlated, the results showed heterogeneity when analyzing the associated risk factors for delayed erythrocyte engraftment. In the analysis of all cases, the requirement for an HLA-matched platelet transfusion was a common risk factor. Furthermore, erythrocyte engraftment was slower in adults than in children. In adults, cytomegalovirus antigenemia was a risk factor for two parameters; however, in children, underlying disease was a common risk factor for all parameters. There is a complex relationship between erythrocyte engraftment and various factors related to HSCTs. Our results suggest that greater accuracy is possible by using analysis methods other than the measurement of reticulocyte levels.
ABO 不相容造血干细胞移植（HSCT）被广泛应用，但红细胞植入延迟可能会引发问题。尽管红细胞植入通常表现为网织红细胞水平升高，无需输注红细胞，但也可以使用其他参数，如受体来源的抗 A/B 同种异体抗体的消失和供体来源的 A/B 抗原的检测。我们对 68 例 ABO 不相容 HSCT 进行了回顾性分析，重点关注主要和双向不匹配。我们使用三种参数（受体来源的抗 A/B 同种异体抗体的消失、供体来源的 A/B 抗原的检测和网织红细胞水平>1%）分析了与红细胞植入延迟相关的已知临床风险因素。尽管这三种参数相关性良好，但在分析与红细胞植入延迟相关的风险因素时，结果显示存在异质性。在所有病例的分析中，HLA 匹配血小板输注的需求是一个共同的风险因素。此外，成人的红细胞植入比儿童慢。在成人中，巨细胞病毒抗原血症是两个参数的风险因素；然而，在儿童中，基础疾病是所有参数的共同风险因素。红细胞植入与与 HSCT 相关的各种因素之间存在复杂的关系。我们的结果表明，使用除网织红细胞水平测量之外的分析方法可以提高准确性。
