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ABO-Mismatched Transplants

ABO-incompatible bone marrow transplantation: a GITMO survey of current practice in Italy and comparison with the literature

Bone Marrow Transplantation volume 34, pages 321–329 (2004)Cite this article

Summary:

ABO incompatibility is not considered a contraindication for allogeneic haematopoietic stem cell transplantation (HSCT) despite its association with several immunohaematological complications. At present, there is no general agreement concerning the best methods to reduce these problems. To survey current practice related to ABO-incompatible HSCT in Italy, a questionnaire was sent to all GITMO centres. Specific questions were addressed for management in pretransplant, peritransplant and post transplant phases. A comparison was made with the experience reported in the literature. In all, 74% of GITMO centres answered the questionnaire. A high degree of heterogeneity concerning the pretransplant tests, methods to overcome infusion of ABO-incompatible marrow and post transplant transfusion policy and monitoring was evident. For many of these aspects the literature does not contain unanimous guidelines. The considerable degree of heterogeneity that reflects, at least partially, the lack of consensus in the literature demonstrates that ABO incompatibility is still an open issue in the setting of HSCT and that further studies are needed for a more rationale approach and for the production of evidence-based guidelines.

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Authors and Affiliations

  1. Department of Haematology, BMT Unit, S Bortolo Hospital, Vicenza, Italy

    R Raimondi & F Rodeghiero

  2. Immunohaematology and Transfusion Service, S Bortolo Hospital, Vicenza, Italy

    M Soli & M Belloni

  3. Department of Haematology-Oncology, BMT Unit, S Martino Hospital, Genoa, Italy

    T Lamparelli & A Bacigalupo

  4. Department of Biopathology, University Tor Vergata, Rome, Italy

    W Arcese

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  1. R Raimondi
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  2. M Soli
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  4. A Bacigalupo
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  6. M Belloni
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on behalf of the Gruppo Italiano Trapianto di Midollo Osseo (GITMO)

Corresponding author

Correspondence to R Raimondi.

Appendix A: Text of the questionnaire

Appendix A: Text of the questionnaire

In the pretransplant phase:

  • do you check for an extensive RBC phenotype (A1, A2, B, D, C, E, c, e, K, k, P1, Fya, Fyb, Kpa, Kpb, Jka, Jkb, Lea, Leb, Lua, Lub, M, N, S, s) and perform an indirect antiglobulin test (IAT) and anti-A/anti-B IHA titration on recipients, family donors and MUD?

  • in the case of HSCT from MUD, on which specimens are these tests performed: peripheral blood used for HLA compatibility test, peripheral blood provided with bone marrow, bone marrow itself or both? do you believe the ABO/Rh(D) group typing performed by the donor centre is sufficient?

In the peritransplant phase:

  • in the case of major ABO incompatibility do you perform PE in the recipient (always, never, only if recipient IHA titre is above a predefined threshold), RBC removal from the donor BM (always, only if recipient IHA titre is above a predefined threshold), and what is the target for residual RBCs?

  • in the case of minor ABO incompatibility do you perform plasma removal from the donor BM (always, only if donor IHA titre is above a predefined threshold)?

  • in the case of major or minor Rh(D) incompatibility what actions do you take: none, RBC removal from the donor BM, PE in the recipient, both RBC removal and PE, plasma removal from the donor BM?

In the posttransplant phase

  • in the case of major ABO incompatibility do you transfuse RBCs compatible with the recipient ABO group, the donor ABO group, the recipient and donor ABO group or only group O RBCs? Do you transfuse platelet concentrates (PC) compatible with the recipient ABO group, the donor ABO group, regardless of ABO groups or only after plasma removal (plasma-poor platelets)? Do you transfuse plasma compatible with the recipient ABO group, donor ABO group, regardless of ABO groups or compatible with either the recipient or donor ABO group?

  • in the case of minor ABO incompatibility: questions identical to those for major ABO incompatibility.

  • how long do you maintain this transfusion policy (1, 2, 3 or 6 months or until recipient RBCs are no longer detectable)?

  • for RBC transfusion do you take into consideration the donor/recipient Rh(D) difference?

  • do you perform ABO/Rh(D) group monitoring, and at which times?

  • do you perform anti-A and anti-B IHA titre monitoring, and at which times?

Participating centres

Ospedali Riuniti Divisione di Ematologia, Bergamo (T Barbui, A Rambaldi); Istituto di Ematologia e Oncologia Medica Seragnoli Ospedale S Orsola, Bologna (S Tura, G Bandini); Università Dipartimento di Scienze Pediatriche, Bologna (G Paolucci, A Pession); Ospedale San Maurizio Dipartimento di Ematologia, Bolzano (P Coser, M Casini); Ospedale Oncologico A. Businco Divisione di Ematologia, Cagliari (G Broccia, P Dessalvi); Università Dipartimento di Scienze Mediche, Cagliari (L Contu, G La Nasa); Ospedale Regionale Microcitemie Clinica Pediatrica, Cagliari (A Cao, F Argiolu); Università Istituto di Ematologia, Catania (R Giustolisi, G Milone); Ospedale Civile Divisione Medica II, sezione Ematologia, Cremona (S Morandi, C Bergonzi); Ospedale di Careggi Dipartimento di Ematologia, Firenze (A Bosi, S Guidi); Ospedale S Martino Dipartimento di Ematologia, Genova (A Bacigalupo, MT Van Lint); Istituto Gaslini, Genova (G Dini, E Lanino); Ospedale di Niguarda Dipartimento di Ematologia, Milano (E Morra, R Cairoli); Ospedale Maggiore IRCCS, Milano (G Lambertenghi Deliliers, A Della Volpe); Ospedale San Gerardo Clinica Pediatrica, Monza (C Uderzo, A Balduzzi); Ospedale San Gerardo Ematologia, Monza (E Pogliani); Ospedale Pausilipon Dipartimento di Ematologia Pediatrica, Napoli (V Poggi, M Ripaldi); Università Divisione di Ematologia, Napoli (B Rotoli, C Selleri); Università Clinica Oncoematologica Pediatria, Padova (L Zanesco, C Messina); Ospedale Cervello Divisione di Ematologia, Palermo (I Majolino, R Scimè); Università Divisione di Ematologia, Palermo (G Mariani, M Musso); Policlinico San Matteo Dipartimento di Ematologia, Pavia (M Lazzarino, EP Alessandrino); Policlinico San Matteo Emato-Oncologia Pediatrica, Pavia (F Locatelli); Università Policlinico Monteluce Dipartimento di Ematologia, Perugia (MF Martelli, F Aversa); Onco-Ematologia Pediatrica, S Andrea delle Fratte Perugia (P Zucchetti); Ospedale Dipartimento di Ematologia, Pesaro (D Gaziev); Ospedale Civile Dipartimento di Ematologia, Pescara (P Di Bartolomeo); Università Clinica Pediatrica, Pisa (C Favre, F Papineschi); Azienda Ospedaliera ‘Bianchi-Malacrino-Morelli’ Divisione di Ematologia, Reggio Calabria (P Iacopino); Università la Sapienza Dipartimento di Biotecnologie Cellulari e Ematologia, Roma (F Mandelli, W Arcese); Università Cattolica Policlinico A Gemelli Ematologia, Roma (P Leone, S Sica); Università Dipartimento di Scienze Pediatriche, Torino (F Fagioli); Università Divisione di Ematologia, Verona (G Pizzolo, F Benedetti); Ospedale S Bortolo Dipartimento di Ematologia, Vicenza (F Rodeghiero, R Raimondi).

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Raimondi, R., Soli, M., Lamparelli, T. et al. ABO-incompatible bone marrow transplantation: a GITMO survey of current practice in Italy and comparison with the literature. Bone Marrow Transplant 34, 321–329 (2004). https://doi.org/10.1038/sj.bmt.1704579

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