异基因造血干细胞移植后免疫血液学监测：104 例患者的单中心前瞻性研究。
Immuno-hematological monitoring after allogeneic stem cell transplantation: a single-center, prospective study of 104 patients.
机构信息
Haematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy.
Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy.
出版信息
Blood Transfus. 2022 Sep;20(5):404-413. doi: 10.2450/2022.0289-21. Epub 2022 Apr 19.
BACKGROUND
The impact of ABO incompatibility on the outcome of hematopoietic stem cell transplantation (HSCT) is still debated. We report the results of a prospective, single-center study evaluating the impact of ABO mismatch on the development of immediate and late immuno-hematological complications, and the efficacy of the protocol used at the "Sapienza" University (Rome, Italy) to manage ABO incompatibility in patients undergoing HSCT.
MATERIALS AND METHODS
From January 2013 to December 2016, we prospectively analyzed all patients undergoing HSCT. Graft manipulation or desensitization strategies were used according to ABO incompatibility, donor sex and donor transfusion history. Red blood cell and platelet transfusions were given based on immunohematological features.
RESULTS
From January 2013 to December 2016, 104 consecutive patients underwent HSCT from a matched related donor (29.81%), matched unrelated donor (53.58%), cord blood (1.9%) or haploidentical donor (14.42%). Forty-nine patients (47%) were ABO-identical and 55 (53%) ABO-incompatible (23 major, 25 minor, 7 bidirectional). Donor engraftment, graft failure or other complications did not differ between ABO compatible or incompatible patients. ABO incompatibility did not show a significant impact on graft-versus-host disease, overall survival or disease-free survival. Factors associated with the need for prolonged red blood cell support were ABO incompatibility (p=0.0395), HLA disparity between donor and recipient (p=0.004) and the onset of hemorrhagic cystitis (p=0.015). In multivariate analysis HLA disparity was the only statistically significant condition (p=0.004).
DISCUSSION
ABO incompatibility does not represent a barrier to allogeneic HSCT. It is, however, associated with prolonged transfusion requirements. Close immunohematological monitoring, as a shared standard procedure, allows appropriate transfusion support to be provided and limits post-HSCT immuno-hematological complications.
背景
ABO 血型不合对造血干细胞移植（HSCT）结果的影响仍存在争议。我们报告了一项前瞻性、单中心研究的结果，该研究评估了 ABO 不匹配对急性和迟发性免疫血液学并发症的发展以及“萨皮恩扎”大学（意大利罗马）在管理 HSCT 患者 ABO 不匹配时使用的方案的疗效的影响。
材料和方法
从 2013 年 1 月至 2016 年 12 月，我们前瞻性分析了所有接受 HSCT 的患者。根据 ABO 不合、供者性别和供者输血史，进行移植物处理或脱敏策略。根据免疫血液学特征给予红细胞和血小板输注。
结果
从 2013 年 1 月至 2016 年 12 月，104 例连续患者接受了来自匹配相关供者（29.81%）、匹配无关供者（53.58%）、脐带血（1.9%）或单倍体供者（14.42%）的 HSCT。49 例（47%）为 ABO 同型，55 例（53%）为 ABO 不合（23 例为主要不合，25 例为次要不合，7 例为双向不合）。ABO 相合或不合患者的供者植入、移植物失败或其他并发症无差异。ABO 不合对移植物抗宿主病、总生存率或无病生存率无显著影响。需要延长红细胞支持的因素包括 ABO 不合（p=0.0395）、供者和受者之间 HLA 差异（p=0.004）和出血性膀胱炎的发生（p=0.015）。多变量分析显示，HLA 差异是唯一具有统计学意义的因素（p=0.004）。
讨论
ABO 不合并不构成异基因 HSCT 的障碍。然而，它与延长输血需求有关。密切的免疫血液学监测，作为一种共同的标准程序，允许提供适当的输血支持，并限制 HSCT 后的免疫血液学并发症。
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