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ABO incompatibility and relapse risk in patients undergoing allogeneic marrow transplantation for acute myeloid leukemia

Bone Marrow Transplantation volume 30, pages 547–548 (2002)Cite this article

We read with interest the recent report by Mehta et al1 in which the authors concluded that relapse rates and event-free survival in patients with acute myeloid leukemia (AML) in first remission were superior after ABO-incompatible compared with ABO-compatible HLA-matched related donor bone marrow transplantation (actuarial 5-year probability of relapse, 12% vs 33%; P = 0.028). Their conclusions were based upon retrospective analysis of data from 119 patients conditioned with cyclophosphamide (n = 72) or melphalan (n = 47) combined with total body irradiation (TBI). Seventy-six patients received ABO-matched, and 43 patients received ABO-mismatched transplants (major ABO-mismatch, n = 16; minor and bidirectional ABO mismatches, n = 27). We believe that the authors’ conclusions are not sufficiently supported by their data and would like to point out several limitations of their study.

First, the significance of their observation disappeared when ABO-incompatible transplants were analyzed according to the directions of the ABO mismatches (major vs minor). The authors interpreted this to suggest a loss of statistical power due to the small sample sizes. They do not comment, however, on the possibility that their apparent association might be due to chance which seems likely given that their findings are not in keeping with results from other studies in which improved relapse-free survival was not detected after ABO-incompatible as compared to ABO-compatible marrow transplantation for AML.2,3,4,5,6,7 Only one group of investigators associated minor and major ABO incompatibility with increased transplant-related mortality resulting from organ toxicity and sepsis possibly due to use of non plasma-depleted platelet products.8 Kalaycioglu et al5 reported that minor and major ABO incompatibility was associated with an improved overall survival in patients with CML (n = 99) but not in those with AML/MDS (n = 100) after marrow transplantation from HLA-identical related donors using a non-TBI containing preparative regimen.

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  1. Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Mailstop D1-100, PO Box 19024, Seattle, WA 98109-1024, USA

    M Mielcarek, B Torok-Storb & R Storb

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Mielcarek, M., Torok-Storb, B. & Storb, R. ABO incompatibility and relapse risk in patients undergoing allogeneic marrow transplantation for acute myeloid leukemia. Bone Marrow Transplant 30, 547–548 (2002). https://doi.org/10.1038/sj.bmt.1703706

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