Impact of ABO incompatibility on outcomes after haploidentical hematopoietic stem cell transplantation for severe aplastic anemia


The impact of ABO incompatibility on transplantation outcomes in severe aplastic anemia (SAA) patients receiving haploidentical hematopoietic stem cell transplantation (HSCT) remains controversial without published data. A total of 199 SAA patients receiving haploidentical HSCT from ABO-matched (n = 114), minor ABO-incompatible (n = 47), or major ABO-incompatible donors (n = 38) were included in this study. The median time and cumulative incidences of both myeloid and platelet engraftment in the ABO-compatible and ABO-incompatible groups were similar, and pure red cell aplasia was absent. Minor ABO incompatibility increased the rate of grade III–IV acute graft-versus-host disease (aGVHD) (ABO compatible: 6.14 ± 0.05%, minor incompatible: 19.15 ± 0.34%, and major incompatible: 10.53 ± 0.25%; P = 0.051), but did not influence the rates of grade II–IV aGVHD or chronic GVHD (cGVHD). Minor ABO-incompatibility was identified as an independent risk factor for grade III–IV aGVHD by multivariate analysis (hazard ration (HR) = 4.00 (1.48–10.80), P = 0.006). Chronic GVHD, mortality, and treatment failure were not increased in the minor ABO-incompatible group. For SAA patients receiving haploidentical HSCT, ABO compatible donors are better than ABO minor incompatible donors if several haploidentical donors are available.

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Fig. 1
Fig. 2: Survival for ABO compatibility, minor ABO incompatibility, and major ABO incompatibility groups.


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This work was partly supported by grants from Innovative Research Groups of the Natural Science Foundation of China (81670167, 81621001), the National Key Research and Development Program of China (2017YFA0104500), National Science and Technology Major Project (2017ZX09304021), and CAMS Innovation Fund for Medical Sciences (CIFMS) (grant number: 2019-I2M-5-034).

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Correspondence to Lan-Ping Xu.

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Y-RM, W-JW, Y-FC, Y-YZ, X-DM, T-TH, F-RW, C-HY, Y-QS, Y-HC, J-ZW, F-FT, WH, YW, X-HZ, X-JH, and L-PX declare that they have no conflict of interest.

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Ma, Y., Wang, W., Cheng, Y. et al. Impact of ABO incompatibility on outcomes after haploidentical hematopoietic stem cell transplantation for severe aplastic anemia. Bone Marrow Transplant (2020) doi:10.1038/s41409-020-0779-7

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