J Korean Med Sci.  2004 Feb;19(1):79-82. 10.3346/jkms.2004.19.1.79.

The Outcomes of Hypertransfusion in Major ABO Incompatible Allogeneic Stem Cell Transplantation

• Park SH
• Lee MH
• Lee SH
• Lee KE
• Park J
• Park JO
• Kim K
• Kim WS
• Jung CW
• Im YH
• Kang WK
• Park K
• Kim SW
• Lee KH
• Lee JH

• KMID: 1785698
• DOI: http://doi.org/10.3346/jkms.2004.19.1.79

Abstract

Major ABO incompatibility may be potentially associated with immediate or delayed hemolysis and delayed onset of erythropoiesis in patients receiving allogeneic hematopoietic stem cell transplantation (HSCT). To determine if hemolysis can be prevented by the inhibition of graft erythropoiesis, we performed hypertransfusion and assessed red cell transfusion requirement and independence. Between October 1995 and December 2001, 28 consecutive patients receiving major ABO incompatible HSCT at Samsung Medical Center were hypertransfused to maintain their hemoglobin levels at 15 g/dL or more. We retrospectively compared the outcomes of these patients with those of 47 patients at Asan Medical Center whose target hemoglobin levels were 10 g/dL. Reticulocyte engraftment was significantly delayed in hypertransfused group (51 days vs. 23 days; p= .001). There was no significant difference in the total amount of red cells transfused within 90 days post-HSCT (25 units vs. 26 units; p= .631). No significant difference in the time to red cell transfusion independence was observed between the two groups (63 days vs. 56 days; p=.165). In conclusion, we failed to improve red cell transfusion requirement and independence in major ABO incompatible HSCT with hypertransfusion.

Keyword

Blood Transfusion; Blood Group Incompatibility; Hemolysis; Hematopoietic Stem Cell Transplantation

MeSH Terms

*ABO Blood-Group System
Adolescent
Adult
*Blood Transfusion
Erythrocytes/metabolism
Erythropoiesis
Female
Hemoglobins/metabolism
Hemolysis
Human
Male
Middle Aged
Retrospective Studies
Stem Cell Transplantation
Time Factors
Transplantation, Homologous
Treatment Outcome

Reference

1. Sniecinski IJ, Oien L, Petz LD, Blume KG. Immunohematologic consequences of major ABO-mismatched bone marrow transplantation. Transplantation. 1988. 45:530–534.

2. Lasky LC, Warkentin PI, Kersey JH, Ramsay NK, McGlave PB, McCullough J. Hemotherapy in patients undergoing blood group incompatible bone marrow transplantation. Transfusion. 1983. 23:277–285.

3. Mehta J, Powles R, Horton C, Milan S, Singhal S, Treleaven J. Relationship between donor-recipient blood group incompatibility and serum bilirubin after allogeneic bone marrow transplantation from HLA-identical siblings. Bone Marrow Transplant. 1995. 15:853–858.

4. Choi KH, Sung HJ, Lee WH, Kim HO, Lyu CJ, Min YH. Red cell depletion from the bone marrow aspirates for the ABO incompatible transplantation by apheresis separations. Korean J Hematol. 2001. 36:318–323.

5. Blacklock HA, Gilmore MJ, Prentice HG, Hazlehurst GR, Evans JP, Ma DD, Knight CB, Hoffbrand AV. ABO-incompatible bone-marrow transplantation: removal of red blood cells from donor marrow avoiding recipient antibody depletion. Lancet. 1982. 2:1061–1064.

6. Tichelli A, Gratwohl A, Wenger R, Osterwalder B, Nissen C, Burri HP, Speck B. ABO-incompatible bone marrow transplantation: in vivo adsorption, an old forgotten method. Transplant Proc. 1987. 19:4632–4637.

7. 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.

8. Worel N, Greinix HT, Schneider B, Kurz M, Rabitsch W, Knobl P, Reiter E, Derfler K, Fischer G, Hinterberger W, Hocker P, Kalhs P. Regeneration of erythropoiesis after related- and unrelated-donor BMT or peripheral blood HPC transplantation: a major ABO mismatch means problems. Transfusion. 2000. 40:543–550.

9. Piomelli S, Karpatkin MH, Arzanian M, Zamani M, Becker MH, Geneiser N, Danoff SJ, Kuhns WJ. Hypertransfusion regimen in patients with Cooley's anemia. Ann N Y Acad Sci. 1974. 232:186–192.

10. 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. 2002. 30:547–548.

11. Goldman J, Liesveld J, Nichols D, Heal J, Blumberg N. ABO incompatibility between donor and recipient and clinical outcomes in allogeneic stem cell transplantation. Leuk Res. 2003. 27:489–491.

12. Worel N, Kalhs P, Keil F, Prinz E, Moser K, Schulenburg A, Mitterbauer M, Mannhalter C, Mayr WR, Schwarzinger I, Hocker P, Lechner K, Greinix HT. ABO mismatch increases transplant-related morbidity and mortality in patients given nonmyeloablative allogeneic HPC transplantation. Transfusion. 2003. 43:1153–1161.

13. Bensinger WI, Buckner CD, Thomas ED, Clift RA. ABO-incompatible marrow transplants. Transplantation. 1982. 33:427–429.