ABO血型不合的异基因骨髓移植

目的 探讨ＨＬＡ 相合,ＡＢＯ 血型不合的异基因骨髓移植（ａｌｌｏＢＭＴ） 中存在的免疫及造血问题。方法 对本所３８ 例ＡＢＯ 血型主要不合,２３ 例次要不合的ＨＬＡ 相合的ａｌｌｏＢＭＴ 受者进行分析,并选用同期ＡＢＯ 血型相合的ａｌｌｏＢＭＴ 患者作配对比较。结果ＡＢＯ 血型不合的ａｌｌｏＢＭＴ患者,输注骨髓后无一例发生急性溶血。经配对ｔ 检验及χ２ 检验,ＡＢＯ 血型不合对骨髓植活、血小板恢复,ＧＶＨＤ 及５ 年无病生存率均无影响; 在ＡＢＯ 血型主要不合组, 红系开始恢复时间明显延迟,使红细胞输用量明显增多;其中５ 例患者发生纯红细胞再生障碍（ 纯红再障） ,持续约７ ～２４ 个月。发生纯红再障者均为“Ｏ”型血受者,红系恢复与血型抗体滴度具有相关性。结论ＡＢＯ 血型不合可以进行ａｌｌｏＢＭＴ,但对发生纯红再障高危的患者宜慎重。

ABO incompatible allogeneic bone marrow transplantation

OBJECTIVE: To explore the immunohematological problems in ABO-incompatible allogeneic bone marrow transplantation (allo-BMT). METHODS: Among 250 HLA-matched allo-BMTs, 61 were performed between ABO incompatible siblings. Out of these 61 BMTs, 38 were major ABO-incompatible and 23, minor. Control group included 61 HLA-matched Allo-BMTs with ABO compatible grafts. The major ABO incompatible patients received marrow grafts depleted of erythrocytes by hydroxyethyl starch (HES) sedimentation. The minor or bidirectional received marrow grafts depleted of plasma to reduce anti-A or anti-B agglutinins. ABO antigen and antibody in the recipients sera were determined once a week. RESULTS: ABO-incompatible grafts for BMT had no adverse effect on engraftment, recovery of platelets, incidence of GVHD or survival. No recipient developed clinically hemolysis during or after marrow infusion. In ABO major compatible group, the onset of erythropoiesis after BMT was delayed and more RBC transfusions were required. Five of 10 recipients with blood group "O" in this group developed pure red cell aplasia (PRCA), lasting 7-24 months. Two of them recovered without therapeutic intervention. In the PRCA patients, the RBC antibody titers remained high for a longer time after BMT than in those whose erythropoiesis reconstituted timely. Serious morbidity related to ABO incompatibility did not occur. CONCLUSION: ABO-incompatible allo-BMT is fairly safe if there is indication, however, PRCA may develop in isolated cases.