主要ABO血型不合异基因造血干细胞移植后纯红细胞再生障碍

目的 研究主要ABO血型不合异基因造血干细胞移植（allo-HSCT）后患者纯红细胞再生障碍（PRCA）的发病情况及危险因素。方法 分析移植后患者PRCA的发病危险因素，比较抗A凝集素与抗B凝集素对红系造血恢复的影响。结果 100例ABO血型主要及主次要均不合allo-HSCT患者中，12例发生PRCA。A供O者9例，A供B者1例，B供O者2例。有抗A凝集素的患者（10例）较有抗B凝集素的患者（2例）易发生PRCA（P〈0．05）。PRCA的发生不影响急性移植物抗宿主病（GVHD）或巨细胞病毒（CMV）感染的发生。发生PRCA时血型转换的中位时问为150．5d，显著长于无PRCA发生患者（60．0d）（P〈0．05）；红系恢复的中位时间为203．5d，显著长于无PRCA发生患者（76．0d）（P〈0．05）。有抗A凝集素的患者血型转换中位时间为90．0d，显著长于有抗B凝集素的患者（55．0d）（P〈0．05）；红系恢复中位时间为98．0d，长于有抗B凝集素者（80．0d）（P〉0．05），但差异无统计学意义。结论 PRCA是ABO血型不合移植的合并症之一。A供O是主要ABO血型小合allo-HSCT后PRCA发病的危险因素。     

ABO血型不合异基因造血干细胞移植后并发纯红系再生障碍

为了研究ABO血型不合异基因造血干细胞移植（allo—HSCT）后并发纯红细胞再生障碍（pure red cell aplasia，PRCA）的发病情况及危险因素，对本医院以往血型不合异基因造血干细胞移植进行回顾性分析。探讨移植后患者PRCA的发病危险因素。研究结果表明，72例ABO血型不合allo—HSCT患者中，4例发生PRCA，其中A供O3例，A供B1例。PRCA的发生不影响急性移植物抗宿主病（GVHD）或巨细胞病毒（CMV）感染的发生。PRCA患者红系恢复的时间显著长于未PRCA发生患者。结论：PRCA是ABO血型不合移植的主要并发症。A供O可能是ABO血型不合allo—HSCT后并发PRCA的危险因素。     

ABO血型不合异基因造血干细胞移植对红系造血恢复的影响

本研究探讨ABO血型不合异基因造血干细胞移植对红系造血的影响。对16例ABO血型不合的造血干移植患者的ABO血型,IgM和IgG抗体进行监测。结果显示,16例ABO血型不合的造血干细胞移植患者均恢复造血功能,与ABO血型相合组比较,ABO血型不合组在粒细胞植活时间、血小板植活时间无差异,但红系重建时间明显延长;ABO主侧不合与双侧不合受者抗供者凝集素消失时间与红系恢复时间有相关性。结论 :ABO血型不合的异基因造血干细胞移植会导致红系造血迟缓。移植前用供型血浆置换法或输注供者红细胞来中和受者体内抗供者红细胞的凝集素能缩短红细胞植入时间,减少红细胞的输注。     

ABO血型不合对异基因造血干细胞移植的影响

目的:探讨ABO血型不合对异基因造血干细胞移植(allo-HSCT)疗效及并发症的影响。方法:对温州医科大学附属第一医院54例接受allo-HSCT的ABO血型不合受者及同期54例ABO血型相合受者进行了比较,观察两组造血重建的特点。结果:ABO血型不合组与相合组对比中的中性粒细胞和血小板重建时间均无明显统计学差异(P0.05),但ABO血型不合allo-HSCT可导致红系恢复延迟,红细胞及血小板输注量增多(P0.01);移植物中CD34~+细胞数量和年龄是影响红系重建的重要因素。ABO血型不合组受者巨细胞病毒(CMV)感染率、急性移植物抗宿主病(aGVHD)发生率及1年、3年总生存率与ABO血型相合组受者比较差异无统计学意义(P0.05)。结论:ABO血型不合组allo-HSCT较ABO血型相合组红系恢复慢,红细胞及血小板输注需求量大;ABO血型不合不影响造血干细胞的植活。     

血型不合的异基因造血干细胞移植治疗恶性血液病

目的探讨ABO血型不合异基因造血干细胞移植的疗效及并发症。方法回顾性分析14例ABO血型不合异基因造血干细胞移植患者的红系恢复情况，以评价血型不合、HLA是否相合等对红系恢复、造血重建、并发症等的影响。结果14洌ABO血型不合患者仅1例发生纯红细胞性再生障碍性贫血（简称：纯红再障），13例ABO血型不合的患者（1例发生纯红再障未计算在内）与同期进行11例ABO血型相同的异基因造血干细胞移植患者比较，血红蛋白恢复在血型不合组明显延迟，中性粒细胞和血小板恢复两组无差异；在血红蛋白恢复和血型转换的时间上血型不合的半相合造血干细胞组明显要迟于全相合，但其差异无统计学意义。结论ABO血型不合不影响造血干细胞移植的植活、相关合并症及预后。     

ABO血型不合的同胞异基因外周血干细胞移植

目的探讨HLA配型相合、ABO血型不合的同胞异基因外周血干细胞移植(alloPBSCT)的疗效。方法对27名HLA配型相合、ABO血型不合的血液恶性肿瘤患者作同胞alloPBSCT(实验组,供、受者ABO血型主侧不合的有15例,次侧不合的有10例,主次侧均不合的有2例),其中急性髓细胞白血病(AML)6例、急性淋巴细胞白血病(ALL)8例、慢性粒细胞性白血病(CMLLP)10例、骨髓增生异常综合征(MDSRAEBT)2例、非霍奇金氏淋巴瘤(ⅣB)1例;并选用同期的35名ABO血型相合的移植患者作比较(对照组)。移植物抗宿主病(GVHD)的预防采用霉酚酸酯(MMF)、环孢菌素A(CSA)和短程甲氨喋呤(MTX)三联预防方案。结果62例全部造血重建。实验组:27名alloPBSCT患者均未出现急性溶血反应,主侧不合者红系造血明显延迟,供/受者血型为A/O的患者中有3例(3/7)发生纯红细胞再生障碍性贫血(PRCA),27名患者于移植后25～153d血型成功转变为供者型;实验组GVHD发生率、VOD发生率、CMV感染、HC发生率及疾病复发率、死亡率与对照组相比差异无统计学意义(P>0.05)。结论ABO血型不合可以进行alloPBSCT,并且不影响干细胞移植的植活、GVHD及其它移植相关并发症的发生和预后。供/受者血型为A/O是主侧ABO血型不合患者alloPBSCT后PRCA发生的高危因素。     

血型不合的异基因造血干细胞移植治疗恶性血液病

目的探讨ABO血型不合异基因造血干细胞移植的疗效及并发症。方法回顾性分析14例ABO血型不合异基因造血干细胞移植患者的红系恢复情况,以评价血型不合、HLA是否相合等对红系恢复、造血重建、并发症等的影响。结果14例ABO血型不合患者仅1例发生纯红细胞性再生障碍性贫血(简称:纯红再障),13例ABO血型不合的患者(1例发生纯红再障未计算在内)与同期进行11例ABO血型相同的异基因造血干细胞移植患者比较,血红蛋白恢复在血型不合组明显延迟,中性粒细胞和血小板恢复两组无差异;在血红蛋白恢复和血型转换的时间上血型不合的半相合造血干细胞组明显要迟于全相合,但其差异无统计学意义。结论ABO血型不合不影响造血干细胞移植的植活、相关合并症及预后。     

ABO血型不合的异基因造血干细胞移植治疗恶性血液病

目的探讨ABO血型不合异基因造血干细胞移植的疗效及并发症。方法回顾性分析14例ABO血型不合异基因造血干细胞移植患者的红系恢复情况，以评价血型不合、HLA是否相合等对红系恢复、造血重建、并发症等的影响。结果14例ABO血型不合患者仅1例发生纯红再障。13例ABO血型不合的患者（1例发生纯红再障未计算在内）与同期进行11例ABO血型相同的异基因造血干细胞移植患者比较，血红蛋白恢复在血型不合组明显延迟，中性粒细胞和血小板恢复两组无差异。此外，在血红蛋白恢复和血型转换的时间上血型不合的半相合造血干细胞组明显要迟于全相合，但其差异无统计学意义。结论ABO血型不合不影响造血干细胞移植的植活、相关合并症及预后。     

ABO血型不合的异基因造血干细胞移植治疗恶性血液病

目的探讨ABO血型不合异基因造血干细胞移植的疗效及并发症。方法回顾性分析14例ABO血型不合异基因造血干细胞移植患者的红系恢复情况,以评价血型不合、HLA是否相合等对红系恢复、造血重建、并发症等的影响。结果14例ABO血型不合患者仅1例发生纯红再障。13例ABO血型不合的患者(1例发生纯红再障未计算在内)与同期进行11例ABO血型相同的异基因造血干细胞移植患者比较,血红蛋白恢复在血型不合组明显延迟,中性粒细胞和血小板恢复两组无差异。此外,在血红蛋白恢复和血型转换的时间上血型不合的半相合造血干细胞组明显要迟于全相合,但其差异无统计学意义。结论ABO血型不合不影响造血干细胞移植的植活、相关合并症及预后。     

ABO血型不合的异基因造血干细胞移植后红系恢复多因素分析

本研究目的是探讨ABO血型不合的异基因造血干细胞移植后影响红系恢复时间的多种因素。应用Cox回归模型对157例ABo血型不合的allo-HSCT患者的性别、年龄、移植方式、HLA相合／HLA不合、预处理方案、GVHD预防、Ⅰ-Ⅳ度GVHD发生、CMV感染及血型不合的类型进行多因素综合分析。结果表明：经Cox回归多因素综合分析，次要血型不合、输注的有核细胞数、年龄和非血缘关系的骨髓移植，为影响红系恢复时间的4个主要因素。结论：次要血型不合及输注细胞数多的患者红系恢复较快，而年龄大和非血缘骨髓移植的患者红系恢复慢。     

ABO血型不合的非清髓异基因外周血干细胞移植

为了探讨ABO血型不合对HLA相合的非清髓异基因外周血干细胞移植(NAST)的影响,回顾分析了15例ABO血型主要不舍,9例次要不合的HLA相合的NAST的临床特点,并选用同期ABO血型相合的NAST作成组比较。结果显示：24例ABO血型不合的NAST受者在输入供者外周血千细胞悬液时无1例发生急性溶血,但有2例发生迟发性溶血。统计学分析表明,ABO血型不合对NAST骨髓植活、血小板恢复、GVHD、疾病复发及无病生存均无影响。在ABO血型主要不合组,红系开始恢复时间明显延迟,其中1例“0”型血受者发生纯红细胞再生障碍,持续5个月。结论：ABO血型不合不是NAST的障碍,仅在ABO血型主要不合时．红系恢复时间延迟。     

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。     

Impact of ABO incompatibility on allogeneic peripheral blood progenitor cell transplantation after reduced intensity conditioning

BACKGROUND: Most studies indicate that ABO incompatibility has no effect on the clinical outcome after allogeneic peripheral blood progenitor cell (PBPC) transplantation (allo-PBPCT). However, it carries additional risks of hemolytic reactions, delayed red blood cell (RBC) engraftment, and pure red cell aplasia (PRCA). Data on these events after reduced intensity conditioning (RIC) regimens are limited, but recent studies have suggested a higher transplant-related mortality (TRM) and morbidity in this setting. STUDY DESIGN AND METHODS: We investigated the impact of ABO-matching on the outcome of 77 patients included in a prospective RIC allo-PBPCT protocol, focusing on engraftment, transfusion requirements, graft-versus-host disease, TRM, and survival. RESULTS: There were 17 (22%) minor and 8 (10%) major ABO-incompatible transplants. No graft failures were observed. After major ABO-incompatible grafts, RBC engraftment was delayed, longer thrombocytopenia periods were documented, and transfusion requirements increased. A transient mild hemolysis occurred in 10 patients, 7 (41%) minor and 3 (37%) major ABO-mismatched. A PRCA was observed in a O+ patient with a pretransplant anti-Jka, grafted from an A + Jka+ donor. Graft-versus-host disease, disease progression, and TRM were not affected by ABO matching. CONCLUSION: ABO incompatibility was not associated with clinically relevant hemolysis after the RIC protocol used and did not impair the clinical outcome. PRCA was only observed in one patient, with a non-ABO RBC allo-antibody.     

Outcomes after major or bidirectional ABO-mismatched allogeneic hematopoietic progenitor cell transplantation after pretransplant isoagglutinin reduction with donor-type secretor plasma with or without plasma exchange

BACKGROUND: Major ABO mismatch in hematopoietic progenitor cell transplantation (HPCT) is associated with a range of immunohematologic consequences including progenitor cell infusion (PCI)‐related hemolysis, delayed red blood cell engraftment, and pure red cell aplasia (PRCA). Although pretransplant (recipient) isoagglutinin reduction may be associated with decreased immunohematologic complications in this setting, there is no consensus with respect to strategies for isoagglutinin reduction. STUDY DESIGN AND METHODS: This observational study assessed the efficacy of a standardized pretransplant isoagglutinin reduction strategy incorporating donor‐type secretor plasma infusions with or without plasma exchange to prevent PCI‐associated hemolysis and PRCA in major or bidirectional ABO‐mismatched peripheral blood HPCT. All major or bidirectional ABO‐mismatched HPCTs performed between 1999 and 2010 were identified from an institutional database. Immunohematologic outcomes were determined retrospectively by review of individual medical records. RESULTS: In total 110 major or bidirectional ABO‐mismatched HPCTs had been performed. No patient developed hemolysis after PCI. With respect to PRCA incidence, 16 patients (15%) were excluded due to early mortality and three (3%) due to incomplete data; of the remaining 91 patients, five (5%) developed PRCA. Patients with PRCA had significantly higher pretransplant isoagglutinin titers (p = 0.0001) compared to those who did not develop PRCA. CONCLUSIONS: Use of a standardized pretransplant isoagglutinin reduction strategy including donor‐type secretor plasma infusions is both safe and efficient in preventing PCI‐associated hemolysis and is associated with low rates of posttransplant PRCA.     

Regeneration of erythropoiesis after related- and unrelated-donor BMT or peripheral blood HPC transplantation: a major ABO mismatch means problems

BACKGROUND: Blood group incompatibility in allogeneic BMT is common but does not appear to affect the outcome in terms of incidence of graft rejection or delayed engraftment. However, major ABO incompatibility may be associated with prolonged erythroid aplasia. STUDY DESIGN AND METHODS: In a retrospective analysis of 286 allogeneic transplant recipients, the prevalence of prolonged erythroid aplasia, including pure RBC aplasia, was determined. RESULTS: Patients receiving major ABO-incompatible grafts showed a significant delay in reticulocyte engraftment (median, 32 days; range, 12-347) from that in patients receiving ABO-identical (20; 10-152) or minor ABO-incompatible (21; 12-47) grafts. Pure RBC aplasia occurred in 7 (3%) of 240 evaluable recipients and was observed only in the major ABO-incompatible group (7/43, 16%). Treatment of pure RBC aplasia consisted of either plasma exchange, which resulted in a response within 16 to 68 days, or immunoadsorption, in which the response occurred between Days 119 and 204 after initiation of treatment. CONCLUSION: Major ABO incompatibility may lead to delayed reticulocyte engraftment, resulting in prolonged transfusion dependency and increased risks of transmission of infection and iron overload. Therefore, therapeutic strategies should be taken into consideration to allow erythroid reconstitution in these patients.