Bone Marrow Transplantation Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China; Institute of Hematology, Zhejiang University, Hangzhou, China; Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China.
Department of Hematology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Transplant Cell Ther. 2022 Jun;28(6):331.e1-331.e10. doi: 10.1016/j.jtct.2022.02.020. Epub 2022 Feb 26.
ABO incompatibility is common in hematopoietic stem cell transplantation (HSCT); however, the impact of donor-recipient ABO compatibility on transplantation outcomes in different HSCT settings is controversial. Moreover, haploidentical stem cell transplantation (haplo-SCT) with peripheral blood stem cell (PBSC)-derived grafts has not been well investigated. The present study aimed to investigate the impact of ABO incompatibility on post-transplantation outcomes, engraftment kinetics, blood product requirements, transfusion independence, and the incidence of poor graft function (PGF) in antithymocyte globulin (ATG)-based haplo-SCT with PBSC grafts during long-term follow-up. We prospectively evaluated 510 patients with hematologic malignancies who underwent haplo-SCT after myeloablative conditioning (MAC). The primary endpoint was overall survival (OS), and secondary endpoints were nonrelapse mortality (NRM), graft-versus-host disease (GVHD), relapse, neutrophil and platelet engraftment, blood transfusion requirements, transfusion independence, and the incidence of PGF. There was no significant association between ABO matching and OS, disease-free survival (DFS), relapse, NRM, grade II-IV acute GVHD, grade III-IV acute GVHD, and moderate and severe chronic GVHD. There were also no significant differences in neutrophil and platelet engraftment, blood transfusion independence, and transfusion requirements at 30, 60, 90, 180, and 365 days post-transplantation among patients with ABO matching and those with minor, major, or bidirectional ABO incompatibility. Donor-recipient ABO matching did not differ significantly according to graft function (good versus poor). ABO incompatibility status has no major impact on patient outcomes in patients with hematologic malignancies undergoing ATG-based MAC haplo-SCT with PBSC-derived grafts.
ABO 血型不合在造血干细胞移植（HSCT）中很常见；然而，不同 HSCT 环境中供受者 ABO 血型相容性对移植结果的影响存在争议。此外，外周血干细胞（PBSC）衍生移植物的单倍体干细胞移植（haplo-SCT）尚未得到充分研究。本研究旨在探讨 ABO 血型不合对 ATG 为基础的 PBSC 衍生移植物的 haplo-SCT 后移植后结局、植入动力学、血液制品需求、输血独立性和差的移植物功能（PGF）发生率的影响，在长期随访中。我们前瞻性评估了 510 例接受清髓性预处理（MAC）后行 haplo-SCT 的血液系统恶性肿瘤患者。主要终点是总生存（OS），次要终点是非复发死亡率（NRM）、移植物抗宿主病（GVHD）、复发、中性粒细胞和血小板植入、血液制品需求、输血独立性和 PGF 的发生率。ABO 匹配与 OS、无病生存（DFS）、复发、NRM、II-IV 级急性 GVHD、III-IV 级急性 GVHD、中重度慢性 GVHD 无显著相关性。在 ABO 匹配和 minor、major 或双向 ABO 不合的患者中，在移植后 30、60、90、180 和 365 天，中性粒细胞和血小板植入、输血独立性和血液制品需求也没有显著差异。根据移植物功能（良好与不良），供受者 ABO 匹配也没有显著差异。ABO 不合状态对接受基于 ATG 的 MAC haplo-SCT 与 PBSC 衍生移植物的血液系统恶性肿瘤患者的预后没有重大影响。
