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ABO incompatibile graft management in pediatric transplantation

A Correction to this article was published on 04 August 2020

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Abstract

Up to 40% of donor-recipient pairs in SCT have some degree of ABO incompatibility, which may cause severe complications. The aim of this study was to describe available options and survey current practices by means of a questionnaire circulated within the EBMT Pediatric Diseases Working Party investigators. Major ABO incompatibility (donor’s RBCs have antigens missing on the recipient’s cell surface, towards which the recipient has circulating isohemagglutinins) requires most frequently an intervention in case of bone marrow grafts, as immediate or delayed hemolysis, delayed erythropoiesis and pure red cell aplasia may occur. RBC depletion from the graft (82%), recipient plasma-exchange (14%) were the most common practices, according to the survey. Graft manipulation is rarely needed in mobilized peripheral blood grafts. In case of minor incompatible grafts (donor has isohemagglutinins directed against recipient RBC antigens), isohemagglutinin depletion from the graft by plasma reduction/centrifugation may be considered, but acute tolerability of minor incompatible grafts is rarely an issue. According to the survey, minor ABO incompatibility was either managed by means of plasma removal from the graft, especially when isohemagglutinin titer was above a certain threshold, or led to no intervention at all (41%). Advantages and disadvantages of each method are discussed.

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Besides the Authors, the following Investigators (in alphabetical order) contributed to the EBMT PD WP survey mentioned in this manuscript:

Bella Bielorai20,21, Simone Cesaro22, Tamara Diesch23, Koji Kato24, Sergio Gomez25, Karin Mellgren26, Julia Palma27, Claudia Rossig28, Martin Sauer29, Petr Sedlacek30, Peter Shaw31, Kirk Schultz32, Jerry Stein33, Güngör Tayfun34, Dominik Turkiewicz35, Jacekz Wachowiak36.

20Department of Pediatric Hematology-Oncology, The Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Ramat-Gan, Israel. 21Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. 22Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. 23University Children’s Hospital Basel, Division of Pediatric Oncology/Hematology, Basel, Switzerland. 24Haematology, Oncology & Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan. 25Stem Cell Transplantation Unit, Hospital de Niños Sor María Ludovica, La Plata, Argentina. 26Institution for Clinical Sciences, Department of Paediatrics, Queen Silvia Children’s Hospital, Gothenburg, Sweden. 27Stem Cell Transplant Unit, Hospital Luis Calvo Mackenna, Santiago, Chile. 28Department of Pediatric Hematology and Oncology, University Children’s Hospital Muenster, Muenster, Germany. 29Department of Pediatric Hematology and Oncology, University Hospital, Hannover Medical School, Hannover, Germany. 30Department of Pediatric Hematology and Oncology, University Hospital Motol, Prague, Czech Republic. 31The Children’s Hospital at Westmead, Oncology Unit, Westmead, Sydney, NSW, Australia. 32Department of Pediatrics, British Columbia Children’s Hospital, British Columbia, Canada. 33Pediatric Hematology Oncology, Schneider Children’s Medical Center of Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 34Division of Stem Cell Transplantation, Department of Pediatrics, University Children’s Hospital, Zürich, Switzerland. 35Children’s Hospital, Skåne University Hospital, Lund, Sweden. 36Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland.

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AB and HB wrote the manuscript, AJ, JHD, RM gave major contributions, PB initiated the Supportive Task Force within the EBMT Pediatric Diseases Working Party and AW coordinated it; all the authors contributed to the survey reported in the manuscript; all authors reviewed the manuscript and approved its final version.

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Correspondence to Adriana Balduzzi.

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Members of the EBMT Pediatric Diseases Working Party are listed before references.

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Balduzzi, A., Bönig, H., Jarisch, A. et al. ABO incompatibile graft management in pediatric transplantation. Bone Marrow Transplant 56, 84–90 (2021). https://doi.org/10.1038/s41409-020-0981-7

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