Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University Frankfurt, University Hospital, Frankfurt/Main, Germany.
Institute of Transfusion Medicine and Immunohematology, Goethe University Frankfurt, Frankfurt, Germany.
Br J Haematol. 2023 Jun;201(6):1159-1168. doi: 10.1111/bjh.18761. Epub 2023 Mar 22.
ABO incompatibility affects approximately 40% of allogeneic stem cell transplants in Caucasian patient populations. Because bone marrow (BM), the preferred graft from paediatric sibling donors and for non-malignant diseases, has a red blood cell (RBC) content similar to blood, anti-donor isoagglutinins must either be depleted from the recipient or RBCs removed from the graft. To achieve tolerability of unmanipulated BM grafts, we used controlled infusions of donor ABO-type RBC units to deplete isoagglutinins before the transplant. This retrospective study evaluates the outcomes of 52 ABO major incompatible BM transplants performed at our centre between 2007 and 2019. The use of donor-type RBC transfusions was well tolerated. They effectively reduced isoagglutinins levels, typically achieving target titres after one (60%) or two (29%) transfusions. The approach allowed for successful and uneventful infusions of unmanipulated BM which provided timely engraftment. The transplant outcomes were not inferior to those of a matched-pair control group of patients with ABO-identical donors.
ABO 不相容性影响约 40%的白种人群异体干细胞移植。由于骨髓（BM）是儿科同胞供体和非恶性疾病的首选移植物，其红细胞（RBC）含量与血液相似，因此必须从受者中去除抗供体同种异体抗体或从移植物中去除 RBC。为了实现未经处理的 BM 移植物的耐受性，我们在移植前使用供体 ABO 型 RBC 单位的控制输注来去除同种异体抗体。本回顾性研究评估了我们中心 2007 年至 2019 年间进行的 52 例 ABO 主要不相容 BM 移植的结果。供体型 RBC 输血的耐受性良好。它们有效地降低了同种异体抗体水平，通常在一次（60%）或两次（29%）输血后达到目标滴度。该方法允许成功且无并发症地输注未经处理的 BM，从而及时进行植入。移植结果与具有 ABO 相同供体的匹配对照组患者的结果无差异。
