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ABO-incompatible marrow transplants.

C D Buckner, R A Clift, J E Sanders

    Transplantation
    |October 1, 1978
    PubMed
    Summary
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    Hematopoietic stem cell transplants can overcome major ABO incompatibilities with pre-transplant plasma exchange, leading to successful engraftment in aplastic anemia and leukemia patients. Minor ABO incompatibility did not impact transplant outcomes in HLA-matched sibling transplants.

    Area of Science:

    • Hematology
    • Transplantation Immunology
    • Oncohematology

    Background:

    • Major ABO incompatibilities pose a significant challenge in hematopoietic stem cell transplantation (HSCT).
    • Pre-transplant interventions are crucial for managing antibody titers in ABO-incompatible HSCT.
    • The impact of minor ABO incompatibility on HSCT outcomes requires further clarification.

    Purpose of the Study:

    • To evaluate the efficacy of plasma and whole blood exchanges in reducing antibody titers for major ABO-incompatible HSCT.
    • To assess engraftment, rejection, and survival rates in patients undergoing major ABO-incompatible HSCT.
    • To compare outcomes of HLA-matched sibling HSCT with ABO-compatible versus minor ABO-incompatible donors.

    Main Methods:

    • Seventeen patients with aplastic anemia or acute leukemia received HSCT from donors with major ABO incompatibilities.

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  • Pre-transplant plasma and whole blood exchanges were performed to decrease antibody titers.
  • A retrospective review compared 246 ABO-compatible HSCTs with 46 minor ABO-incompatible HSCTs in HLA-matched siblings.

    • Main Results:

    • All 17 patients in the major ABO-incompatible group successfully engrafted following pre-transplant plasma exchange.
    • One potential rejection occurred in a patient with the highest pre-transplant anti-A IgG titer; 9 of 17 patients survived.
    • Minor ABO incompatibility showed no significant effect on graft rejection, graft-versus-host disease, or survival in HLA-matched sibling transplants.

    Conclusions:

    • Plasma and whole blood exchanges are effective in mitigating major ABO incompatibilities for successful HSCT engraftment.
    • Major ABO-incompatible HSCT can achieve successful engraftment and survival, though careful monitoring for rejection is warranted.
    • Minor ABO incompatibility does not appear to adversely affect outcomes in HLA-matched sibling HSCT.