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ABO Compatibility

Transplantation of ABO-incompatible bone marrow and peripheral blood stem cell components

Bone Marrow Transplantation volume 26, pages 749–757 (2000)Cite this article

Abstract

Hemolysis may occur during infusion of an ABO-incompatible HSC component if the recipient has isoagglutinins directed against donor red blood cells, or later as a result of the production by donor lymphocytes of isoagglutinins directed against recipient ABO-antigens. Peripheral blood stem cell (PBSC) components collected by apheresis contain few red cells but considerably greater numbers of lymphocytes than marrow. We reviewed the transplant courses of 158 recipients of marrow (n = 90) or PBSC (n = 68) from HLA-identical, ABO-incompatible sibling donors. No patient experienced immediate or delayed hemolysis attributable to the ABO incompatibility. Recipients of minor ABO-incompatible red cell-replete marrow required fewer red cell transfusions during the first week after transplantation than recipients of PBSC or marrows depleted of red cells; the red cell transfusion requirements for the following 3 weeks did not differ. The maximum level of bilirubin did not differ for patients classified by ABO incompatibility or source of HSC. The development of positive antiglobulin tests occurred for eight marrow recipients from a separate group of 22 patients (17 marrow, five PBSC) for whom this testing was performed. None of these patients developed overt hemolysis. These data indicate that hemolysis complicating ABO-incompatible transplantation is not common after either marrow or PBSC transplantation. Bone Marrow Transplantation (2000) 26, 749–757.

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References

  1. Gale RP, Feig S, Ho W et al. ABO blood group system and bone marrow transplantation Blood 1977 50: 185–194

    CAS  PubMed  Google Scholar 

  2. Buckner CD, Clift RA, Sanders JE et al. ABO-incompatible marrow transplants Transplantation 1978 26: 233–238

    Article  CAS  Google Scholar 

  3. Dinsmore RE, Reich LM, Kapor N et al. ABH incompatible bone marrow transplantation: removal of erythrocytes by starch sedimentation Br J Haematol 1983 54: 441–449

    Article  CAS  Google Scholar 

  4. Braine HG, Sensenbrenner LL, Wright SK et al. Bone marrow transplantation with major ABO blood group incompatibility using erythrocyte depletion of marrow prior to infusion Blood 1982 60: 420–425

    CAS  PubMed  Google Scholar 

  5. Sniecinski IJ, O’Donnell MR . Hemolytic complications of hematopoietic cell transplantation. In: Thomas ED, Blume KG, Forman SJ (eds) Hematopoietic Cell Transplantation Blackwell Science: Malden 1999 pp674–684

    Google Scholar 

  6. Warkentin PI, Yomtovian R, Hurd D et al. Severe delayed hemolytic transfusion reaction complicating an ABO-incompatible bone marrow transplantation Vox Sang 1983 45: 40–47

    Article  CAS  Google Scholar 

  7. Marmont AM, Damasio EE, Bacigalupo A et al. A to O bone marrow transplantation in severe aplastic anaemia: dynamics of blood group conversion and demonstration of early dyserythropoiesis in the engrafted marrow Br J Haematol 1977 36: 511–518

    Article  CAS  Google Scholar 

  8. Benjamin RJ, Connors JM, McGurk S et al. Prolonged erythroid aplasia after major ABO-mismatched transplantation for chronic myelogenous leukemia Biol Blood Marrow Transplant 1998 4: 151–156

    Article  CAS  Google Scholar 

  9. Bar BMAM, Van Dijk BA, Schattenberg A et al. Erythrocyte repopulation after major ABO incompatible transplantation with lymphocyte-depleted bone marrow Bone Marrow Transplant 1995 16: 793–799

    CAS  PubMed  Google Scholar 

  10. Hows J, Beddow K, Gordon-Smith E et al. Donor-derived red blood cell antibodies and immune hemolysis after allogeneic bone marrow transplantation Blood 1986 67: 177–181

    CAS  PubMed  Google Scholar 

  11. Gajewski JL, Petz LD, Calhoun L et al. Hemolysis of transfusion group O red blood cells in minor ABO-incompatible unrelated-donor bone marrow transplants in patients receiving cyclosporine without posttransplant methotrexate Blood 1992 79: 3076–3085

    CAS  PubMed  Google Scholar 

  12. Greeno EW, Perry EH, Ilstrup SJ, Weisdorf DJ . Exchange transfusion the hard way: massive hemolysis following transplantation of bone marrow with minor ABO incompatibility Transfusion 1996 36: 71–74

    Article  CAS  Google Scholar 

  13. Toren A, Dacosta Y, Manny N et al. Passenger B-lymphocyte-induced severe hemolytic disease after allogeneic peripheral blood stem cell transplantation Blood 1996 87: 843–844

    CAS  PubMed  Google Scholar 

  14. Bornhauser M, Ordemann R, Paaz U et al. Rapid engraftment after allogeneic ABO-incompatible peripheral blood stem cell transplantation complicated by severe hemolysis Bone Marrow Transplant 1997 19: 295–297

    Article  CAS  Google Scholar 

  15. Laurencet FM, Samii K, Bressoud A et al. Massive delayed hemolysis following peripheral blood stem cell transplantation with minor ABO incompatibility Hematol Cell Ther 1997 39: 159–162

    Article  CAS  Google Scholar 

  16. Oziel-Taieb S, Faucher-Barbey C, Chabannon C et al. Early and fatal immune haemolysis after so-called ‘minor’ ABO-incompatible peripheral blood stem cell allotransplantation Bone Marrow Transplant 1997 19: 1155–1156

    Article  CAS  Google Scholar 

  17. Salmon JP, Michaux S, Hermanne JP et al. Delayed massive immune hemolysis mediated by minor ABO incompatibility after allogeneic peripheral blood progenitor cell transplantation Transfusion 1999 39: 824–827

    Article  CAS  Google Scholar 

  18. Matthews DC, Appelbaum FR, Eary JF et al. Phase I study of (131)I-anti-CD45 antibody plus cyclophosphamide and total body irradiation for advanced acute leukemia and myelodysplastic syndrome Blood 1999 94: 1237–1247

    CAS  PubMed  Google Scholar 

  19. Storb R, Deeg HJ, Thomas ED et al. Marrow transplantation for chronic myelocytic leukemia: a controlled trial of cyclosporine versus methotrexate for prophylaxis of graft-versus-host disease Blood 1985 66: 698–702

    CAS  PubMed  Google Scholar 

  20. Storb R, Pepe M, Anasetti C et al. What role for prednisone in prevention of acute graft-versus-host disease in patients undergoing marrow transplants? Blood 1990 76: 1037–1045

    CAS  PubMed  Google Scholar 

  21. Fleming GF, Schilsky RL . Antifolates: the next generation Semin Oncol 1992 19: 707–719

    CAS  PubMed  Google Scholar 

  22. Thomas ED, Storb R . Technique for human marrow grafting Blood 1970 36: 507–515

    CAS  PubMed  Google Scholar 

  23. Bensinger WI, Clift R, Martin P et al. Allogeneic peripheral blood stem cell transplantation in patients with advanced hematologic malignancies: a retrospective comparison with marrow transplantation Blood 1996 88: 2794–2800

    CAS  PubMed  Google Scholar 

  24. Cassens U, Ostkamp-Ostermann P, Garritsen H et al. Efficacy and kinetics of bone marrow processing and enrichment of haematopoietic progenitor cells (HPC) by a large-volume apheresis procedure Bone Marrow Transplant 1997 19: 835–840

    Article  CAS  Google Scholar 

  25. Mehta J, Powles R, Horton C et al. Relationship between donor–recipient blood group incompatibility and serum bilirubin after allogeneic bone marrow transplantation from HLA-identical siblings Bone Marrow Transplant 1995 15: 853–858

    CAS  PubMed  Google Scholar 

  26. Byrnes JJ, Hussein AM . Thrombotic microangiopathic syndromes after bone marrow transplantation Cancer Invest 1996 14: 151–157

    Article  CAS  Google Scholar 

  27. Mielcarek M, Leisenring W, Banaji M et al. Graft-versus-host disease and donor-directed hemagglutinin titers after ABO-mismatched related and unrelated marrow allografts: evidence for a graft-versus-plasma cell effect Blood 1999 94: (Suppl. 1) 711a

    Google Scholar 

  28. Bensinger WI, Clift R, Martin P et al. Allogeneic peripheral blood stem cell transplantation in patients with advanced hematologic malignancies: a retrospective comparison with marrow transplantation Blood 1996 88: 2794–2800

    CAS  PubMed  Google Scholar 

  29. Karhi KK, Andersson LC, Vuopio P, Bahmberg CG . Expression of blood group A antigens in human bone marrow cells Blood 1981 57: 147–151

    CAS  PubMed  Google Scholar 

  30. Hazelhurst GR, Brenner MK, Wimperis JZ et al. Hemolysis after T-cell depleted bone marrow transplantation involving minor ABO incompatibility Scand J Haematol 1986 37: 1–3

    Article  Google Scholar 

  31. Rosental GJ, Weigand GW, Germolec DR et al. Suppression of B cell function by methotrexate and trimetrexate – evidence for inhibition of purine biosynthesis as a major mechanism of action J Immunol 1988 141: 410–416

    Google Scholar 

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Acknowledgements

We wish to acknowledge the staffs of the Transfusion Office, Apheresis Unit, Clinical Cryobiology Laboratory, and the inpatient and outpatient transplant wards of the Fred Hutchinson Cancer Research Center for their role in the management of patients undergoing ABO-incompatible hematopoietic stem cell transplantation. Funding for this project was provided in part by grant numbers CA18029 and CA15704 from the National Cancer Institute, Bethesda, MD.

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  1. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    PS Liang & L Ulz

  2. Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, PO Box 19024, D5–390, Seattle, 98109–1024, WA, USA

    SD Rowley

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Rowley, S., Liang, P. & Ulz, L. Transplantation of ABO-incompatible bone marrow and peripheral blood stem cell components. Bone Marrow Transplant 26, 749–757 (2000). https://doi.org/10.1038/sj.bmt.1702572

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