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Allografting

Major ABO-incompatible BMT: isohemagglutinin reduction with plasma exchange is safe and avoids graft manipulation

Bone Marrow Transplantation volume 48, pages 953–957 (2013)Cite this article

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Abstract

The impact of donor–recipient ABO incompatibility on long-term BMT outcomes remains controversial. A common strategy is to deplete the donor marrow of red cells, although this variably reduces the number of CD34+ cells. This 10-year retrospective study assessed the impact of recipient plasma exchange in major ABO-incompatible allogeneic BMT on outcomes and survival. Target Ab titres were⩽1:4 for anti-A and⩽1:8 for anti-B. Patients with higher titres underwent plasma exchange before marrow infusion. Of 133 patients who underwent allogeneic BMT, 34 had a major ABO-incompatible donor. The median number of exchanges was 2 (range 1–4). There were no acute haemolytic transfusion reactions. Engraftment times, transfusion requirements and acute and chronic GVHD were no different from those of patients with an ABO-identical donor. Treatment-related mortality at 100 days was 21% in the group with a major ABO-incompatible donor and 17% in the group with an identical donor (P=0.8). Plasma exchange of the recipient is a safe method of managing donor–recipient major ABO incompatibility before BMT without the risk of haematopoietic progenitor cell loss associated with red cell depletion of the graft.

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References

  1. Worel N, Kalhs P . AB0-incompatible allogeneic hematopoietic stem cell transplantation. Haematologica 2008; 93: 1605–1607.

    Article  PubMed  Google Scholar 

  2. Rowley SD . Hematopoietic stem cell transplantation between red cell incompatible donor-recipient pairs. Bone Marrow Transplant 2001; 28: 315–321.

    Article  CAS  PubMed  Google Scholar 

  3. Gmur J, Burger J, Schaffner A, Neftel K, Oelz O, Frey D et al. Pure red cell aplasia of long duration complicating major ABO-incompatible bone marrow transplantation [see comments]. Blood 1990; 75: 290–295.

    CAS  PubMed  Google Scholar 

  4. Griffith LM, McCoy JP, Bolan CD, Stroncek DF, Pickett AC, Linton GF et al. Persistence of recipient plasma cells and anti-donor isohaemagglutinins in patients with delayed donor erythropoiesis after major ABO incompatible non-myeloablative haematopoietic cell transplantation. Br J Haematol 2005; 128: 668–675.

    Article  CAS  PubMed  Google Scholar 

  5. Kimura F, Sato K, Kobayashi S, Ikeda T, Sao H, Okamoto S et al. Impact of AB0-blood group incompatibility on the outcome of recipients of bone marrow transplants from unrelated donors in the Japan Marrow Donor Program. Haematologica 2008; 93: 1686–1693.

    Article  PubMed  Google Scholar 

  6. Stussi GMJ, Passeg JR, Seebach L, Schanz U, Gmur J, Gratwohl A et al. Consequences of ABO incompatibility in allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2002; 30: 87–93.

    Article  CAS  PubMed  Google Scholar 

  7. Blin N, Traineau R, Houssin S, Peffault de Latour R, Petropoulou A, Robin M et al. Impact of donor-recipient major ABO mismatch on allogeneic transplantation outcome according to stem cell source. Biol Blood Marrow Transplant: J Am Soc Blood Marrow Transplant 2010; 16: 1315–1323.

    Article  Google Scholar 

  8. Remberger M, Watz E, Ringdén O, Mattsson J, Shanwell A, Wikman A . Major ABO blood group mismatch increases the risk for graft failure after unrelated donor hematopoietic stem cell transplantation. Biol Blood Marrow Transplant: J Am Soc Blood Marrow Transplant 2007; 13: 675–682.

    Article  Google Scholar 

  9. Resnick IB, Tsirigotis PD, Shapira MY, Aker M, Bitan M, Samuel S et al. ABO incompatibility is associated with increased non-relapse and GVHD related mortality in patients with malignancies treated with a reduced intensity regimen: a single center experience of 221 patients. Biol Blood Marrow Transplant: J Am Soc Blood Marrow Transplant 2008; 14: 409–417.

    Article  CAS  Google Scholar 

  10. Benjamin RJ, McGurk S, Ralston MS, Churchill WH, Antin JH . ABO incompatibility as an adverse risk factor for survival after allogeneic bone marrow transplantation. Transfusion 1999; 39: 179–187.

    Article  CAS  PubMed  Google Scholar 

  11. Canals C, Muñiz-Díaz E, Martínez C, Martino R, Moreno I, Ramos A et al. Impact of ABO incompatibility on allogeneic peripheral blood progenitor cell transplantation after reduced intensity conditioning. Transfusion 2004; 44: 1603–1611.

    Article  PubMed  Google Scholar 

  12. Seebach JD, Stussi G, Passweg JR, Loberiza FR, Gajewski JL, Keating A et al. ABO blood group barrier in allogeneic bone marrow transplantation revisited. Biol Blood Marrow Transplant: J Am Soc Blood Marrow Transplant 2005; 11: 1006–1013.

    Article  Google Scholar 

  13. Kanda J, Ichinohe T, Matsuo K, Benjamin RJ, Klumpp TR, Rozman P et al. Impact of ABO mismatching on the outcomes of allogeneic related and unrelated blood and marrow stem cell transplantations for hematologic malignancies: IPD-based meta-analysis of cohort studies. Transfusion 2009; 49: 624–635.

    Article  PubMed  Google Scholar 

  14. Roback JCM, Grossman B, Hillyer C (eds).. Technical Manual of the American Association of Blood Banks. American Association of Blood Banks: Bethesda, 2008.

    Google Scholar 

  15. Gale R, Feig S, Ho W, Falk P, Rippee C, Sparkes R . ABO blood group system and bone marrow transplantation. Blood 1977; 50: 185–194.

    CAS  PubMed  Google Scholar 

  16. Stussi G, Halter J, Schanz U, Seebach JD . ABO-histo blood group incompatibility in hematopoietic stem cell and solid organ transplantation. Transfusion and Apheresis Science: Official Journal of the World Apheresis Association: Off J Eur Soc Haemapheresis 2006; 35: 59–69.

    Google Scholar 

  17. Bensinger WIBC, Thomas ED, Clift RA . ABO-incompatible marrow transplants. Transplantation 1982; 33: 427–429.

    Article  CAS  PubMed  Google Scholar 

  18. Raimondi R, Soli M, Lamparelli T, Bacigalupo A, Arcese W, Belloni M et al. ABO-incompatible bone marrow transplantation: a GITMO survey of current practice in Italy and comparison with the literature. Bone Marrow Transplant 2004; 34: 321–329.

    Article  CAS  PubMed  Google Scholar 

  19. Brecher M (ed).. AABB Technical Manual 15th edn. American Association of Blood Banks: Bethesda, MD, 2005.

    Google Scholar 

  20. Lasky LC, WP (eds). Marrow and Stem Cell Processing for Transplantation. AABB: Bethesda, 1995.

    Google Scholar 

  21. Lazarus HM, Kan F, Tarima S, Champlin RE, Confer DL, Frey N et al. Rapid transport and infusion of hematopoietic cells is associated with improved outcome after myeloablative therapy and unrelated donor transplant. Biol Blood Marrow Transplant: J Am Soc Blood Marrow Transplant 2009; 15: 589–596.

    Article  Google Scholar 

  22. Bar BVDB, Schattenberg A, de Man AJ, Kunst V, de Witte T . Erythrocyte repopulation after major ABO incompatible transplantation with lymphocyte-depleted bone marrow. Bone Marrow Transplant 1995; 16: 793–799.

    CAS  PubMed  Google Scholar 

  23. Reviron JSC, Bussel A, Devergie A, Gluckman E . Evidence for different kinds of major ABO incompatibility in transplantation due to the interplay of qualitative and quantitative factors: application to the management of 62 bone marrow recipients. Transplant Proc 1987; 18: 4623–4628.

    Google Scholar 

  24. Braine H, Sensenbrenner L, Wright S, Tutschka P, Saral R, Santos G . 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 

  25. Stussi G, Halter J, Bucheli E, Valli PV, Seebach L, Gmür J et al. Prevention of pure red cell aplasia after major or bidirectional ABO blood group incompatible hematopoietic stem cell transplantation by pretransplant reduction of host anti-donor isoagglutinins. Haematologica 2009; 94: 239–248.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Anasetti C, Logan BR, Lee SJ, Waller EK, Weisdorf DJ, Wingard JR et al. Increased incidence of chronic graft-versus-host disease (GVHD) and no survival advantage with filgrastim-mobilized peripheral blood stem cells (PBSC) compared to bone marrow (BM) transplants from unrelated donors: results of blood and marrow transplant clinical trials network (BMT CTN) protocol 0201, a phase III, prospective, randomized trial. ASH Annual Meeting and Exposition. San Diego, California, USA, 2011.

    Google Scholar 

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Acknowledgements

At the time of this work, DS was a University of Ottawa Centre for Transfusion Research Fellow supported by Canadian Blood Services and the Ottawa Hospital Blood and Marrow Programme and through an unrestricted educational grant from Celgene. We acknowledge Lisa Martin, Canadian Blood Services, for providing graft composition information.

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  1. Division of Hematology, Department of Medicine, Blood and Marrow Transplant Program, The Ottawa Hospital, Ottawa, Ontario, Canada

    D Sheppard, J Tay, A Bryant, S McDiarmid, L Huebsch, M Tokessy, L Hamelin, E Saidenberg & C Bredeson

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  1. D Sheppard
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Correspondence to D Sheppard.

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Sheppard, D., Tay, J., Bryant, A. et al. Major ABO-incompatible BMT: isohemagglutinin reduction with plasma exchange is safe and avoids graft manipulation. Bone Marrow Transplant 48, 953–957 (2013). https://doi.org/10.1038/bmt.2012.264

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