ABO 血型不合不影响血液恶性肿瘤患者经清髓性预处理后无关脐血移植的输血需求或临床结局。
ABO incompatibility does not affect transfusion requirements or clinical outcomes of unrelated cord blood transplantation after myeloablative conditioning for haematological malignancies.
机构信息
Department of Blood Transfusion, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
Haematology Department, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
出版信息
Blood Transfus. 2022 Mar;20(2):156-167. doi: 10.2450/2021.0080-21. Epub 2021 Jul 2.
BACKGROUND
The effects of ABO incompatibility on cord blood transplantation (CBT) have not been confirmed. We retrospectively investigated the effect of ABO incompatibility on the clinical outcomes and changes of isoagglutinin titres of 261 consecutive patients who underwent CBT in a single centre.
MATERIAL AND METHODS
We studied patients with haematological malignancies undergoing unrelated CBT following myeloablative conditioning. There were 80 matched, 72 major mismatched, 72 minor mismatched, and 37 bidirectional mismatched transplants. Risk factors that could potentially influence the patients' outcomes were evaluated. Immunoglobulin M (IgM) isohaemagglutinin antibody (IHA) titres were determined 1 day before and 2, 4, 6 and 8 weeks after the transplant.
RESULTS
ABO mismatches did not influence engraftment, transfusion requirements, event-free survival or overall survival following CBT. The anti-donor IgM serum IHA titres fell to ≤1:8 at week 8 after CBT in all patients with ABO major and bidirectional mismatches. The percentages of patients requiring platelet and red blood cell transfusions in the period 31-61 days after CBT were markedly lower than in the period 0-30 days after CBT, being 15 vs 99% for platelets and 23 vs 78% for red blood cells, respectively. Of the 69 recipients of minor mismatched CBT tested, only three with AB blood type developed low titres of anti-recipient IHA after 5 months.
DISCUSSION
In this study ABO incompatibility did not affect clinical outcomes after CBT. A higher number of CD34 cells infused was correlated with earlier engraftment. Severe acute graft-versus-host disease was associated with poor overall survival. As the IHA titre decreased, so did the number of patients requiring blood transfusion. Rapidly decreasing anti-donor IHA titres and the non-production of donor anti-recipient A and/or B antibodies might contribute to a good outcome of ABO-incompatible CBT with myeloablative conditioning for haematological malignancies.
背景
ABO 血型不合对脐血移植（CBT）的影响尚未得到证实。我们回顾性研究了 ABO 血型不合对 261 例在单中心接受非亲缘性 CBT 的血液系统恶性肿瘤患者的临床结局和同种异体血凝素滴度变化的影响。
材料和方法
我们研究了接受清髓性预处理的无关供者 CBT 的血液系统恶性肿瘤患者。有 80 例匹配、72 例主要不合、72 例次要不合和 37 例双向不合移植。评估了可能影响患者结局的危险因素。在移植前 1 天和移植后 2、4、6 和 8 周测定免疫球蛋白 M（IgM）同种异体血凝素抗体（IHA）滴度。
结果
ABO 血型不合不影响 CBT 后的植入、输血需求、无事件生存或总生存。在所有 ABO 主要和双向不合的患者中，CBT 后 8 周抗供者 IgM 血清 IHA 滴度降至≤1:8。在 CBT 后 31-61 天与 0-30 天期间，需要血小板和红细胞输血的患者比例明显降低，血小板分别为 15%和 99%，红细胞分别为 23%和 78%。在接受次要不合的 CBT 的 69 例受者中，仅 3 例 AB 血型的受者在 5 个月后出现低滴度的抗受者 IHA。
讨论
在这项研究中，ABO 不合不影响 CBT 后的临床结局。输注的 CD34 细胞数量较多与更早的植入有关。严重的急性移植物抗宿主病与总体生存不良相关。随着 IHA 滴度的降低，需要输血的患者数量也减少。快速降低的抗供者 IHA 滴度和不产生供者抗受者 A 和/或 B 抗体可能有助于在血液系统恶性肿瘤的清髓性预处理下实现良好的 ABO 不相容性 CBT 结局。
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