scholarly journals The impact of donor type and ABO incompatibility on transfusion requirements after nonmyeloablative haematopoietic cell transplantation

2010 ◽  
Vol 149 (1) ◽  
pp. 101-110 ◽  
Author(s):  
Zejing Wang ◽  
Mohamed L. Sorror ◽  
Wendy Leisenring ◽  
Gary Schoch ◽  
David G. Maloney ◽  
...  
Keyword(s):  
Cell Transplantation ◽  
Abo Incompatibility ◽  
Haematopoietic Cell ◽  
Transfusion Requirements ◽  
Donor Type ◽  
The Impact

Transfusion Requirements in Allogeneic Hematopoietic Cell Transplantation (HCT) Recipients Given Either Myeloablative or Nonmyeloablative Conditioning, and Effect of ABO Incompatibility on HCT Outcomes.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3268-3268
Author(s):  
Zejing Wang ◽  
Mohamed L. Sorror ◽  
Wendy Leisenring ◽  
Gary Schoch ◽  
David G. Malonely ◽  
...  
Keyword(s):  
Graft Rejection ◽  
Acute Gvhd ◽  
Hematopoietic Cell Transplantation ◽  
Reference Group ◽  
P Value ◽  
Chi Square ◽  
Abo Incompatibility ◽  
Transfusion Requirements ◽  
The Impact ◽  
Rbc Transfusion

Abstract We retrospectively assessed 1) overall platelet (PLT) and red blood cell (RBC) transfusion requirements within the first 100 days after allogeneic among HCT recipients given either nonmyeloablative (n=365) or myeloablative conditioning (n=1430); 2) transfusion requirements among nonmyeloablative recipients given grafts from related (n=187) vs. unrelated donors (n=178), and grafts from ABO matched (n=203) vs. ABO mismatched donors (n=159); and 3) the impact of ABO incompatibility on HCT outcomes among nonmyeloablative recipients. Table 1 summarizes results. We confirmed that myeloablative recipients were more likely to receive both PLT and RBC transfusions than nonmyeloablative recipients (both p<0.0001). Subsequent analyses were restricted to nonmyeloablative recipients. Both PLT and RBC transfusion requirements were increased among recipients of unrelated grafts (both p<0.0001) and those with major or bi-directional ABO mismatched grafts (p = 0.019 and p=0.003, respectively). No statistically significant differences were observed in cumulative incidences of graft rejection/failure, grades II-IV acute GVHD and in 3-year survivals between ABO-matched, minor-mismatched, and major/bidirectional mismatched pts (p=0.89, 0.48, and 0.49, respectively). Times to disappearance of anti-donor IgM and IgG isohemagglutinins were not statistically significantly different among major or bi-directional ABO mismatched related (43 days for both) vs. unrelated recipients (58 and 57 days, p=0.20 and 0.27, respectively). Major/bidirectional ABO-mismatched recipients with grades II-IV vs. 0–I acute GVHD had comparable likelihoods of reaching IgM (p=0.20) and IgG (p=0.63) titer endpoints. In conclusion, nonmyeloablative pts had reduced PLT and RBC transfusion requirements compared to myeloablative pts. Among nonmyeloablative pts, unrelated (vs. related) grafts and ABO-incompatibility (vs. ABO compatibility) between donors and recipients led to increased PLT and RBC transfusion requirements. ABO incompatibility did not increase graft rejection nor GVHD or adversely affect survival after non-myeloablative HCT. The tempo of disappearance of anti-donor isohemagglutinin titers was not influenced by donor type or occurrence of GVHD. Table 1. Percentage of patients requiring at least one PLT or RBC transfusion. % of Patients Requiring Transfusions N PLT p-value† RBC p-value† † p-value from Chi-square test. * Reference group for comparisons. £ Information were missing from 3 patients. Non-myeloablative 365 36% * 76% * Myeloablative 1430 99% <0.0001 96% <0.0001 Non-myeloablative Related grafts 187 25% * 67% * Unrelated grafts 178 47% <0.0001 86% <0.0001 Non-myeloablative£ ABO-matched 203 33% * 70% * ABO minor mismatched 79 33% 0.95 80% 0.11 Major bi-directional ABO-mismatched 80 48% 0.019 88% 0.003 Non-myeloablative ABO-mismatched Related grafts 66 32% * 77% * Unrelated grafts 93 46% 0.068 88% 0.067

Allogeneic Stem Cell Transplantation From Unrelated One-Antigen HLA-Mismatched Donor, Increases Acute II-IV Gvhd Incidence without Interfering with Other Post-Transplant Complications

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2378-2378
Author(s):  
Eva De Berranger ◽  
Louis Terriou ◽  
Valérie Coiteux ◽  
Leonardo Magro ◽  
Françoise Dufossé ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Sibling Donor ◽  
Wide Range ◽  
Donor Type ◽  
The Impact ◽  
Mismatched Donor ◽  
Matched Donor

Abstract Abstract 2378 Allogeneic stem cell transplantation (allo-SCT) offers potential curative treatment of for a wide range of otherwise fatal hematological diseases. However, only one third of patients have an HLA-identical sibling donor. We have previously reported that in patients with standard risk malignancy, transplantation from unrelated HLA-allellically matched donors (10/10) led to outcomes similar to those from HLA-identical sibling donors (Yakoub-Agha et al, JCO 2006). Indeed, with the increase in the number of single-child families, stem cell grafts from unrelated donors are being increasingly used and more than 30% of patients eligible for allo-CST, are still lacking a well-matched donor. In the attempt to investigate the impact of unrelated one-antigen HLA-mismatched graft, we report a single center retrospective study on 209 patients who underwent allo-CST from identical HLA-sibling donor (n=123), unrelated HLA-matched donor (10/10) (n=73) and unrelated one-antigen-HLA-mismatched donor (9/10) (n=13) over the last 5 years. In order to homogenize our cohort, patients with CML, aplastic anemia or lymphoproliferative disorder were excluded from the study. Therefore, underlying diseases were AML (n=104), ALL (n=54), myelodysplastic syndrome (n=30), and myeloproliferative syndrome (n=21). Of the 117 (56%) males patients, 49 (23%) received graft from female donor (classical sex-mismatch). Medians age of recipients and donors at transplantation were 45.2 years (4.4-65.5) and 40.8 years (2.0-67.5), respectively. Patients received conditioning regimens using either myeloablative (n=149) including 81 who received High-dose TBI (12Gy) or nonmyeloablative (n=60) including 48 who received low-dose TBI (2Gy). Antithymoglobulin was given to 25 pts. Bone marrow was the main source of stem cells (n=150; 72%). Results: with the median of follow-up of 37.9 months, 78 patients died including 25 from TRM. Relapse was recorded in 70 patients. Seventy-two patients experienced acute GVHD (aGVHD) including 47 with II-IV grades and 30 with III-IV grades. In multivariate analyses, donor type (unrelated regardless the degree of HLA-matching vs related) and conditioning (nonmyeloablative vs myeloablative) were the most important risk factors negatively influencing the overall survival [p=.002; HR=2.038 and p=.016; HR=1.81, respectively) and event-free survival (p=.005; HR=1.783 and p=.015; HR=1.728, respectively). As expected, the only factor that influenced the risk of relapse was the conditioning type (nonmyeloablative vs myeloablative) (p=.048; HR=1.699) while donor type was found to influence TRM (p=.030; HR=2.428). Graft from unrelated one-antigen HLA-mismatched donor (9/10) was the foremost risk factor for acute grade II-IV GVHD (p=.019; HR=2.663; [95%CI: 1.178–6.019]). In conclusion, except for acute II-IV GHVD, allo-CST from unrelated one-antigen HLA-mismatched donor (9/10), seemed to led to outcomes similar to those from HLA-identical unrelated donor (10/10) and may be considered as an alternative option for patients without a full-matched donor. Prospective studies are warranted, however, to confirm our data in larger cohort of patients. Disclosures: No relevant conflicts of interest to declare.

Impact Of ABO Incompatibility On Overall Survival After Unrelated Cord Blood Transplantation a Single Institute Experience In China

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5535-5535
Author(s):  
Sun Zimin ◽  
Ji Mengmeng ◽  
Yao Wen ◽  
Zheng Changcheng ◽  
Tong Juan ◽  
...  
Keyword(s):  
Cord Blood ◽  
Clinical Outcomes ◽  
Conflicts Of Interest ◽  
Cord Blood Transplantation ◽  
Disease Free Survival ◽  
Pure Red Cell Aplasia ◽  
Blood Transplantation ◽  
Abo Incompatibility ◽  
Transfusion Requirements ◽  
The Impact

Abstract Umbilical cord blood transplantation (UCBT) has now become a more common treatment for patients with hematologic malignancies who lack matched related or unrelated donors. However, few reports have addressed the impact of ABO incompatibility on the clinical outcomes, such as engraftment, transfusion requirements and survival after UCBT. Therefore, we retrospectively analyzed the impact of ABO mismatching on the clinical outcomes of 121 patients, including 51 ABO-identical, 23 minor, 39 major, and 8 bidirectional ABO-incompatible recipients after UCBT. With a median follow-up of 11 months (range, 5-151 months), the disease-free survival (DFS) rates among the ABO-identical, minor, major, and bidirectional ABO-incompatible groups were 71.7%, 60.0%, 37.1%, and 71.4%, respectively (P=0.014), whereas the OS did not differ significantly among the four groups (76.1%, 65.0%, 48.6%, and 71.4%, respectively; P=0.078). The DFS (68.2%, 42.9%; P=0.009) and OS estimates (72.7%, 52.4%; P=0.031) of the ABO identical/minor incompatible group also differed significantly from the ABO major/bidirectional incompatible group. These results were confirmed in the multivariate analysis. No significant differences in the engraftment times, transfusion requirements, graft-versus-host disease (GVHD), relapse, and non-relapse mortality (NRM) were noted among the groups. Severe immune hemolysis or pure red cell aplasia did not occur among these patients. These results indicate that ABO incompatibility somewhat affects the DFS and OS in UCBT, but further studies are still required. Disclosures: No relevant conflicts of interest to declare.

Impact of ABO Incompatibility on Engraftment , Transfusion Requirement and Survival after Unrelated Cord Blood Transplantation：a Single Institute Experience in China

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2586-2586
Author(s):  
Jiawei Yan ◽  
Guangyu Sun ◽  
Wen Yao ◽  
Lei Zhang ◽  
Xiang Wan ◽  
...  
Keyword(s):  
Cord Blood ◽  
Clinical Outcomes ◽  
Pure Red Cell Aplasia ◽  
Red Cell ◽  
Abo Incompatibility ◽  
Transfusion Requirements ◽  
Significant Difference ◽  
Unrelated Cord Blood ◽  
The Impact ◽  
Neutrophil Engraftment

Abstract Few reports have focused on the impact of ABO incompatibility on the clinical outcomes, after unrelated cord blood transplantation (UCBT). Therefore, we retrospectively analyzed the impact of ABO mismatching on the clinical outcomes of 177 patients with hematologic malignancies, which underwent single UCBT in Anhui Provincial Hospital from May 2008 to April 2014. The study patients included 86 ABO-identical, 52 minor, 32 major, and 11 bidirectional ABO-incompatible recipients. All of them received a homogeneous intensified myeloablative pre-transplantation conditioning regimen of total body irradiation (TBI)cyclophosphamide (CY) [TBI (total,12 Gy; four fractions) and CY (60 mg/kg daily for 2 days)] (age≥14 years) or BuCY2 [busulfan (0.8 mg/kg every 6 h for 4 days) and CY]. Medians of 3.85×107/kg (range, 1.03-10.43) total nucleated cell (TNC) and 2.0×105/kg (range, 0.45-6.88) CD34+cells were transfused. Of the 177 patients who underwent UCBT, 169 achieved successful neutrophil engraftment. In patients receiving ABO-identical, minor, major, and bidirectional ABO-incompatible UCBT, the cumulative incidences of neutrophil engraftment were 92.7%, 100%, 96.9% and 90.9%, respectively (P=0.509). The median days to achieve neutrophil engraftment were 17, 18, 17, and 20, respectively (P=0.409). The cumulative incidences of platelet engraftment were 81.7%, 86.5% , 87.5% and 63.6%, respectively(P=0.436) .And the median days to achieve platelet engraftment for the 4 groups were 36, 40, 36, and 38, respectively; (P=0.545). All of the data did not show any significant difference among the 4 groups. Neutrophil engraftment(cumulative incidence, 95.5% versus 95.3% , P=0.861; median day, 17 versus 18, P=0.717) also did not differ significantly between the ABO-identical/minor ABO-incompatible and major/bidirectional ABO-incompatible recipients (HR1.08, P=0.680). And platelet engraftment (83.6% versus 81.4%, P=0.964; median day, 38 versus 37, P=0.699) reached the similar result (HR1.104, P=0.621). We investigated the results from a 169-patient population with neutrophil engraftment, the average units of platelets (Plts) and red blood cells (RBCs) transfused during the hospitalization after the UCBT were 0.204 units/kg(range, 0.03-1.45)and 0.159 units/kg (range, 0-1.56).In patients with ABO-identical, minor, major, and bidirectional ABO-incompatible UCBT, the average units of Plts transfused after UCBT were 0.221, 0.202, 0.169, and 0.195 units/kg(P=0.53), respectively, and the average units of RBCs transfused were 0.151, 0.156, 0.163, and 0.221 units/kg (P=0.847), respectively. No significant differences in the transfusion requirements among the 4 groups were noted, so did the comparison between the ABO-identical/minor ABO-incompatible and major/bidirectional ABO-incompatible recipients. With a median follow-up of 12 months (range, 3-74 months), the disease-free survival (DFS) rates among the ABO-identical, minor, major, and bidirectional ABO-incompatible groups were 67.1%, 57.7%, 62.5 % and 54.5%, respectively (P=0.804), and the overall survival (OS) also did not differ significantly among the four groups (68.3%, 61.5%, 65.6%, and 63.6%, respectively; P=0.929). When it came to the comparison between the ABO identical/minor incompatible group and the ABO major/bidirectional incompatible group, the DFS (63.4% versus 60.5%; P=0.995) and OS estimates (65.7% versus 65.1%; P=0.820) were not significantly different, either. What’s more, none of the patients clinical developed severe immune hemolysis or pure red-cell aplasia after transplantation. In summary, the results above indicated that :1) ABO incompatibility did not seem to have a significant impact on clinical outcomes after UCBT, such as engraftment, transfusion requirements and survival. 2) No patients developed pure red-cell aplasia after UCBT. 3) In addition, we also compared the outcomes between the ABO-identical and bidirectional ABO-incompatible groups, even it did not show any significant difference, the former did better on platelet engraftment (81.7% versus 63.6%) and DFS (67.1 versus 54.5%). The reason led to this result may be the lack of bidirectional ABO-incompatible recipients. Therefore, we’d better avoid selecting bidirectional ABO-incompatible in UCBT to improve the patients’ recovery and survival time. Disclosures No relevant conflicts of interest to declare.

Impact of Donor/Recipient Major ABO Mismatch on Allogeneic Transplantation Outcome According to Stem Cell Source: Results from An 809-Patient Retrospective Study.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2157-2157
Author(s):  
Nicolas Blin ◽  
Richard Traineau ◽  
Régis de Latour ◽  
Marie Robin ◽  
Agnes Devergie ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Stem Cell ◽  
Median Time ◽  
Relapse Rate ◽  
Statistical Significance ◽  
Allogeneic Transplantation ◽  
Abo Incompatibility ◽  
Stem Cell Source ◽  
Transfusion Requirements ◽  
Donor Type

Abstract ABO incompatibility between donor and recipient is not considered a barrier for successful allogeneic hematopoietic stem cell transplantation (HSCT). However, it is well established that major ABO incompatibility is associated with several immunohematological complications such as delayed hemolysis, delayed erythropoiesis, pure red cell aplasia and prolonged transfusion requirements due to the persistent presence of host-derived antibodies. Nevertheless, conflicting data still exist as to its influence on graft-versus-host disease (GvHD) incidence, relapse rate and survival. To further investigate the relevance of ABO major mismatch on transplant outcome, we retrospectively analyzed results from 414 patients with major or major/minor ABO-mismatched related and unrelated allogeneic transplantation performed between 1978 and 2005. Of the 414 patients, 226 (55%) received bone marrow (BM), 138 (33%) peripheral blood stem cells (PBSC) and 49 (12%) cord blood (CB) transplantation. Transplants were performed for both malignant (71%) and non malignant (29%) hematological diseases using myeloablative (81%) and non myeloablative (19%) conditioning regimens. Transplant outcome was assessed by comparison with results from a 395-patient ABO-compatible population with similar characteristics with respect to period of transplant, stem cell source, conditioning regimen, GvHD prophylaxis and donor type. Median time to red cells transfusion independence was significantly longer in ABO-incompatible marrow recipients (median time 63 days vs. 41 days, p=0.001) with faster disappearance of anti-donor IgM hemagglutinins in unrelated recipients (median time 36 days vs. 44 days, p=0.03) and in patients with grade≥2 aGVHD (median time 35 days vs. 59 days, p=0.001). However, erythroid reconstitution was not significantly delayed in PBSC and CB transplantation, whatever donor type or aGVHD occurrence. A strong correlation between ABO incompatibility and GVHD incidence was found in PBSC recipients with a 2.1-fold increased likelihood (1.8–3.1, 95% CI, p=0.01) of developing grade≥2 aGVHD, all patients receiving cyclosporine A-based prophylaxis regimen. An effect of ABO mismatch was also found on relapse rate and overall survival in that population but without reaching statistical significance (35% vs. 41%, p=0.055 and 39 months vs. 34 months, p=0.055). Among CB transplant recipients, we also found an impact of ABO incompatibility on neutrophil engraftment with borderline statistical significance (median time to reach neutrophil count&gt;1000/μL: 29 days vs. 23 days, p=0.05). No effect was seen on platelet recovery, GvHD incidence or relapse rate in this subgroup. When performing multivariate analysis in Cox regression model for effect on relapse rate in the whole population, donor/recipient ABO mismatch and c.GVHD appeared to be the 2 only factors associated with a lower risk of relapse (RR=0.65, 95% CI, p=0.04 and RR=0.55, 95% CI, p=0.035, respectively). Overall, our results confirm the impact of aGVHD and donor type in red blood cells transfusion requirements in bone marrow ABO-mismatched recipients. They also tend to show beneficial impact of ABO incompatibility on relapse rate, especially in PBSCT. Taken together, these data may influence donor choice, i.e.: select ABO-matched donor for bone marrow and cord blood transplants (to favor hematological recovery) and, may be ABO mismatched donor for peripheral blood transplants with the aim to stimulate alloreactivity in patients with hematological malignancy.

Sign in / Sign up

Export Citation Format

Share Document