Abstract：
OBJECTIVE: ABO incompatibility does not hinder bone marrow transplantation (BMT), but it has been associated with worse outcomes and additional adverse events. This study aimed to verify the impact of incompatible red blood cells (iRBCs) in allogeneic BMT and to determine a safe number of iRBCs to be infused.
METHODS: We compared ABO-incompatible (iABO) allogeneic BMT (n = 42) with ABO-compatible allogeneic BMT (n = 44) and evaluated the impact of the number of infused iRBCs on outcomes and adverse events.
RESULTS: The iABO patients demonstrated delayed time to transfusion independence at 30 days and 60 days, increased requirement for red blood cell (RBC) transfusion and greater hemolysis signals and incidence of pure red cell aplasia. Neutrophil/platelet engraftment, length of hospitalization post-transplant, platelet units required, graft-versus-host disease occurrence and overall survival were similar in both groups. Patients in the iABO group received 1.03 × 1010 iRBCs/kg (range, 0.36-3.88). Infusion of iRBCs >1.0 × 1010 /kg was related to graft failure or death before neutrophil engraftment or platelet engraftment or both as well as increased plasma requirement and increased creatinine. Our results also suggest that antibody titers impact the transplantation scenario.
CONCLUSIONS: The iABO transplantation showed some unfavorable outcomes. It is important to monitor the value of iRBCs to be infused, considering the recipient antibody titers. We propose using the number of iRBCs (iRBCs/kg) as a dose parameter with regard to infused iRBCs. Further studies are necessary to clarify the maximum safe number of iRBCs in iABO transplants.
METHODS: We compared ABO-incompatible (iABO) allogeneic BMT (n = 42) with ABO-compatible allogeneic BMT (n = 44) and evaluated the impact of the number of infused iRBCs on outcomes and adverse events.
RESULTS: The iABO patients demonstrated delayed time to transfusion independence at 30 days and 60 days, increased requirement for red blood cell (RBC) transfusion and greater hemolysis signals and incidence of pure red cell aplasia. Neutrophil/platelet engraftment, length of hospitalization post-transplant, platelet units required, graft-versus-host disease occurrence and overall survival were similar in both groups. Patients in the iABO group received 1.03 × 1010 iRBCs/kg (range, 0.36-3.88). Infusion of iRBCs >1.0 × 1010 /kg was related to graft failure or death before neutrophil engraftment or platelet engraftment or both as well as increased plasma requirement and increased creatinine. Our results also suggest that antibody titers impact the transplantation scenario.
CONCLUSIONS: The iABO transplantation showed some unfavorable outcomes. It is important to monitor the value of iRBCs to be infused, considering the recipient antibody titers. We propose using the number of iRBCs (iRBCs/kg) as a dose parameter with regard to infused iRBCs. Further studies are necessary to clarify the maximum safe number of iRBCs in iABO transplants.
摘要：
目的：ABO不相容不妨碍骨髓移植（BMT），但它与更差的结局和其他不良事件有关.这项研究旨在验证同种异体BMT中不相容红细胞（iRBC）的影响，并确定要输注的iRBC的安全数量。
方法：我们比较了ABO不相容（iABO）同种异体BMT（n=42）和ABO相容同种异体BMT（n=44），并评估了输注iRBC的数量对结局和不良事件的影响。
结果：iABO患者在30天和60天表现出延迟的输血独立时间，红细胞（RBC）输血需求增加，溶血信号增加，纯红细胞再生障碍发生率增加。中性粒细胞/血小板植入，移植后的住院时间，需要血小板单位，两组移植物抗宿主病发生率和总生存期相似.iABO组患者接受1.03×1010iRBC/kg（范围，0.36-3.88)。输注iRBC>1.0×1010/kg与中性粒细胞植入或血小板植入或两者之前的移植物失败或死亡以及血浆需求增加和肌酐增加有关。我们的结果还表明抗体滴度影响移植方案。
结论：iABO移植显示出一些不利的结果。重要的是要监测要输注的iRBC的价值，考虑受体抗体滴度。我们建议使用iRBC的数量（iRBC/kg）作为输注iRBC的剂量参数。需要进一步的研究来阐明iABO移植中iRBC的最大安全数量。
方法：我们比较了ABO不相容（iABO）同种异体BMT（n=42）和ABO相容同种异体BMT（n=44），并评估了输注iRBC的数量对结局和不良事件的影响。
结果：iABO患者在30天和60天表现出延迟的输血独立时间，红细胞（RBC）输血需求增加，溶血信号增加，纯红细胞再生障碍发生率增加。中性粒细胞/血小板植入，移植后的住院时间，需要血小板单位，两组移植物抗宿主病发生率和总生存期相似.iABO组患者接受1.03×1010iRBC/kg（范围，0.36-3.88)。输注iRBC>1.0×1010/kg与中性粒细胞植入或血小板植入或两者之前的移植物失败或死亡以及血浆需求增加和肌酐增加有关。我们的结果还表明抗体滴度影响移植方案。
结论：iABO移植显示出一些不利的结果。重要的是要监测要输注的iRBC的价值，考虑受体抗体滴度。我们建议使用iRBC的数量（iRBC/kg）作为输注iRBC的剂量参数。需要进一步的研究来阐明iABO移植中iRBC的最大安全数量。
