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Logan AC, Wang Z, Alimoghaddam K, Wong RM, Lai T, Negrin RS, Grumet C, Logan BR, Zhang MJ, Spellman SR, Lee SJ, Miklos DB. ABO mismatch is associated with increased nonrelapse mortality after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 2015; 21:746-54. [PMID: 25572032 PMCID: PMC4363312 DOI: 10.1016/j.bbmt.2014.12.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 12/29/2014] [Indexed: 11/16/2022]
Abstract
We evaluated ABO associated outcomes in 1737 patients who underwent allogeneic hematopoietic cell transplantation (allo-HCT) at Stanford University between January 1986 and July 2011. Grafts were 61% ABO matched, 18% major mismatched (MM), 17% minor MM, and 4% bidirectional MM. Median follow-up was 6 years. In multivariate analysis, overall survival (OS) was inferior in minor MM hematopoietic cell transplantations (median 2.1 versus 6.3 years; hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.19 to 2.05; P = .001) in comparison with ABO-matched grafts. ABO minor MM was associated with an increase in early nonrelapse mortality (NRM) (18% versus 13%; HR, 1.48; 95% CI, 1.06 to 2.06; P = .02). In an independent Center for International Blood and Marrow Transplant Research (CIBMTR) analysis of 435 lymphoma patients receiving mobilized peripheral blood grafts, impairment of OS (HR, 1.55; 95% CI, 1.07 to 2.25; P = .021) and increased NRM (HR, 1.72; 95% CI, 1.11 to 2.68; P = .03) were observed in recipients of ABO minor-MM grafts. A second independent analysis of a CIBMTR data set including 5179 patients with acute myeloid leukemia and myelodysplastic syndrome identified a nonsignificant trend toward decreased OS in recipients of ABO minor-MM grafts and also found ABO major MM to be significantly associated with decreased OS (HR, 1.19; 95% CI, 1.08 to 1.31; P < .001) and increased NRM (HR, 1.23; 95% CI, 1.08 to 1.4; P = .002). ABO minor and major MM are risk factors for worse transplantation outcomes, although the associated hazards may not be uniform across different transplantation populations. Further study is warranted to determine which patient populations are at greatest risk, and whether this risk can be modified by anti-B cell therapy or other peri-transplantation treatments.
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Affiliation(s)
- Aaron C Logan
- Division of Hematology and Blood and Marrow Transplantation, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Zhiyu Wang
- Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Kamran Alimoghaddam
- Hematology, Oncology, and Stem Cell Transplantation, Tehran University of Medical Sciences, Tehran, Iran
| | - Ruby M Wong
- Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Tze Lai
- Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Robert S Negrin
- Division of Blood and Marrow Transplantation, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Carl Grumet
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Brent R Logan
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mei-Jie Zhang
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Stephen R Spellman
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | | | - David B Miklos
- Division of Blood and Marrow Transplantation, Department of Medicine, Stanford University School of Medicine, Stanford, California.
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Yahng SA, Lee JW, Kim Y, Kim M, Oh EJ, Park YJ, Lee JW, Cho B, Han K. New proposed guidelines for early identification of successful myeloid and erythroid engraftment in hematopoietic stem cell transplantation. J Clin Lab Anal 2014; 28:469-77. [PMID: 24659310 DOI: 10.1002/jcla.21712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 10/25/2013] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND After hematopoietic stem cell transplantation (HSCT), early detection of engraftment would be of critical value for clinicians. The aim of this study was to identify faster parameters for engraftment. METHODS We evaluated blood cell parameters including complete blood count (CBC), differential counts, and various reticulocyte parameters in 115 patients who received HSCT (allogeneic, n = 93; autologous, n = 22) in the purpose of identifying possible improved laboratory guidelines for engraftment prediction. RESULTS AND CONCLUSION Days to white blood cell (WBC) count over 100 cells/μl with more than two-fold increase from nadir after transplantation (proposed new WBC guideline) preceded absolute neutrophil count (ANC) >500 cells/μl by 1.7 days. Among erythroid parameters, the earliest marker for erythroid engraftment was high light scattering reticulocytes (HLR) >0.1 (proposed new red blood cell guideline), which preceded reticulocyte counts (RET) >1% and immature reticulocyte fraction >0.5 by 3.9 and 1.6 days, respectively. Among the clinical parameters compared, those with statistically significant influence on myeloid engraftment were donor type (P = 0.009) and conditioning intensity (P = 0.009). As for erythroid recovery, ABO incompatibility was the only significant factor. In conclusion, the new guidelines may ensure engraftment several days earlier than the conventional parameters, which may help clinicians for decision-making on rescue therapy earlier.
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Affiliation(s)
- Seung-Ah Yahng
- Department of Hematology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Irradiation induces homing of donor endothelial progenitor cells in allogeneic hematopoietic stem cell transplantation. Int J Hematol 2012; 95:189-97. [DOI: 10.1007/s12185-011-1000-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Revised: 12/13/2011] [Accepted: 12/13/2011] [Indexed: 10/14/2022]
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Mueller RJ, Stussi G, Puga Yung G, Nikolic M, Soldini D, Halter J, Meyer-Monard S, Gratwohl A, Passweg JR, Odermatt B, Schanz U, Biedermann BC, Seebach JD. Persistence of recipient-type endothelium after allogeneic hematopoietic stem cell transplantation. Haematologica 2010; 96:119-27. [PMID: 20934999 DOI: 10.3324/haematol.2010.030288] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The possibility that allogeneic hematopoietic stem cell transplantation performed across the ABO blood group-barrier is associated with an increase of graft-versus-host disease, in particular endothelial damage, has not been elucidated so far. For this reason, we investigated the level of endothelial cell chimerism after allogeneic hematopoietic stem cell transplantation in order to delineate the role of hematopoietic stem cells in endothelial replacement. DESIGN AND METHODS The frequency of donor-derived endothelial cells was analyzed in 52 hematopoietic stem cell transplant recipients, in 22 normal skin biopsies, in 12 skin samples affected by graft-versus-host disease, various tissues from five autopsies and four secondary solid tumors by ABH immunohistochemistry, XY fluorescence in situ hybridization and short tandem repeat analysis of laser captured endothelial cells. RESULTS Skin biopsies from two patients transplanted with minor ABO-incompatible grafts (i.e. O in A) showed 3.3% and 0.9% H antigen-positive donor-derived endothelial cells by ABH immunohistochemistry. Tumor biopsies from two recipients showed 1.2% and 2.5% donor-derived endothelial cells by combined immunohistochemistry/ fluorescence in situ hybridization. All other skin samples, heart, liver, bone-marrow, and tumor tissues failed to reveal donor-type endothelial cells up to several years after ABO-incompatible hematopoietic stem cell transplantation. CONCLUSIONS Endothelial cell replacement by bone marrow-derived donor cells after allogeneic hematopoietic stem cell transplantation is a rare event. It does not seem to represent a major mechanism of physiological in vivo blood vessel formation, tumor neoangiogenesis, vascular repair after graft-versus-host disease episodes or acceptance of ABO-incompatible grafts.
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Affiliation(s)
- Regula J Mueller
- Laboratory for Transplantation Immunology, University Hospital, Zurich, Switzerland
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Stussi G, Halter J, Bucheli E, Valli PV, Seebach L, Gmür J, Gratwohl A, Schanz U, Passweg JR, Seebach JD. Prevention of pure red cell aplasia after major or bidirectional ABO blood group incompatible hematopoietic stem cell transplantation by pretransplant reduction of host anti-donor isoagglutinins. Haematologica 2009; 94:239-48. [PMID: 19144657 DOI: 10.3324/haematol.13356] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Persistent anti-donor isoagglutinins after major ABO blood group incompatible hematopoietic stem cell transplantation may cause delayed red blood cell engraftment and post-transplant pure red cell aplasia. DESIGN AND METHODS We investigated the effect of pretransplant anti-donor isoagglutinin reduction by in vivo absorption and/or plasmapheresis on the incidence of pure red cell aplasia and the time to red blood cell engraftment in 153 hematopoietic stem cell transplant recipients with major ABO incompatibility. RESULTS Twelve patients (8%) developed pure red cell aplasia, 3/98 (3%) with, and 9/55 (16%) without prior isoagglutinin reduction (p=0.009). Red blood cell engraftment was faster in patients with isoagglutinin reduction; in addition, peripheral blood hematopoietic stem cell transplantation, acute graft-versus-host disease, and younger age were associated with faster red blood cell engraftment in Cox regression analysis. In patients with pure red cell aplasia the mean red blood cell engraftment occurred after 225 days (p<0.001) and was associated with a simultaneous decrease of anti-donor isoagglutinins. Patients with pure red cell aplasia had higher pretransplant anti-donor isoagglutinin titers (p=0.001) and received more post-transplant red blood cell transfusions (p<0.001). CONCLUSIONS Following major ABO incompatible hematopoietic stem cell transplantation, pure red cell aplasia and delayed red blood cell engraftment depend on the levels of anti-donor isoagglutinins and are efficiently prevented by the pretransplant removal of these isoagglutinins. The benefits of reducing the time of transfusion-dependency and transfusion-associated risks must be carefully balanced against the potential side effects of isoagglutinin reduction.
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Affiliation(s)
- Georg Stussi
- Clinic for Hematology and Laboratory for Transplantation Immunology, Department of Internal Medicine, University Hospital, Zürich, Switzerland.
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Kanda J, Ichinohe T, Matsuo K, Benjamin RJ, Klumpp TR, Rozman P, Blumberg N, Mehta J, Sohn SK, Uchiyama T. Impact of ABO mismatching on the outcomes of allogeneic related and unrelated blood and marrow stem cell transplantations for hematologic malignancies: IPD-based meta-analysis of cohort studies. Transfusion 2009; 49:624-35. [PMID: 19170998 DOI: 10.1111/j.1537-2995.2008.02043.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The impact of donor-recipient ABO matching on outcomes after allogeneic stem cell transplantation has been a matter of controversy. STUDY DESIGN AND METHODS Individual patient data-based meta-analysis was conducted with a pooled data set provided through six published and one unpublished cohorts. Outcomes in recipients of peripheral blood or bone marrow transplantation for hematologic malignancies were evaluated. A multivariate Cox model was used to adjust differences in outcomes of patients receiving ABO-matched grafts with those receiving major, minor, or bidirectional mismatched grafts. Considering multiple testing, p values of less than 0.05 and 0.001 were considered significant for the primary and secondary endpoints, respectively. RESULTS In all, 1208 cases, including 697 ABO-matched and 202 major, 228 minor, and 81 bidirectional mismatched transplants, were analyzed. Overall, adverse impact of ABO matching on overall survival (OS), as a primary endpoint, was not observed (adjusted hazard ratios [95% confidence intervals]: major, 1.03 [0.82-1.30], p = 0.81; minor, 1.19 [0.97-1.47], p = 0.10; bidirectional, 1.25 [0.91-1.72], p = 0.17). Among related stem cell recipients, ABO matching had no significant influence on OS, while the minor and bidirectional mismatched groups among unrelated stem cell recipients exhibited lower OS with marginal significance, especially in patients with acute leukemia, patients who received transplants after 1998, and patients who underwent transplants at Asian centers. CONCLUSIONS Our meta-analysis demonstrates no adverse association between any ABO mismatching and survival. However, marginally lower OS found in recipients of minor or bidirectional mismatched grafts from unrelated donors suggested the need for larger studies focusing on unrelated transplants.
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Affiliation(s)
- Junya Kanda
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan.
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Shimada M, Onizuka M, Machida S, Suzuki R, Kojima M, Miyamura K, Kodera Y, Inoko H, Ando K. Association of autoimmune disease-related gene polymorphisms with chronic graft-versus-host disease. Br J Haematol 2007; 139:458-63. [PMID: 17868046 DOI: 10.1111/j.1365-2141.2007.06797.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Chronic graft-versus-host disease (GVHD) is the most common cause of poor outcomes after haematopoietic stem cell transplantation (HSCT), while the pathophysiology of chronic GVHD remains poorly understood. As both chronic GVHD and autoimmune disease share clinical features, we speculated that autoimmune disease-related genes might be candidate chronic GVHD-related genes. Recent large-scale cohort studies showed that Fc receptor-like 3 gene (FCRL3) single nucleotide polymorphism (SNP) and peptidylarginine deiminases citrullinating enzymes 4 gene (PADI4) haplotype were associated with autoimmune disease. The present study investigated the association between polymorphisms of these two genes and the incidence of chronic GVHD. We analysed 123 cases of Japanese human leucocyte antigen-matched sibling recipients and their donors who underwent HSCT. Although PADI4, which is the rheumatoid arthritis-specific related gene, was not associated with the occurrence of chronic GVHD, the recipient FCRL3-169C/C genotype was significantly less frequent in chronic GVHD patients than in those without chronic GVHD (P = 0.0086). There was no relationship between FCRL3 polymorphism and acute GVHD. As FCRL3 is expressed by B cells and might have an important role in immunoregulation, this significant protective genetic effect raises the question of whether FCRL3 might also be involved in the pathogenesis of chronic GVHD.
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Affiliation(s)
- Masako Shimada
- Department of Haematology and Oncology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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Worel N, Greinix HT, Leitner G, Mitterbauer M, Rabitsch W, Rosenmayr A, Höcker P, Kalhs P. ABO-incompatible allogeneic hematopoietic stem cell transplantation following reduced-intensity conditioning: Close association with transplant-associated microangiopathy. Transfus Apher Sci 2007; 36:297-304. [PMID: 17569587 DOI: 10.1016/j.transci.2007.03.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Accepted: 03/20/2007] [Indexed: 10/23/2022]
Abstract
Transplant-associated microangiopathy (TAM) is a severe complication following allogeneic hematopoietic stem cell transplantation (HSCT) even after reduced-intensity conditioning (RIC). Data on 112 patients following RIC were analyzed with respect to TAM according to the ASBMT and risk factors, response to well-defined therapy and outcome were determined. TAM occurred in 11 of 112 patients. Univariate analysis determined acute graft-versus-host disease and ABO-incompatibility as risk factors for TAM. Treatment consisted of withdrawal of calcineurin inhibitors and plasma exchange (PE). Response to PE was 64%. PE seems to be an effective therapeutic option that should be assessed in larger patient cohorts.
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Affiliation(s)
- Nina Worel
- Department of Blood Group Serology and Transfusion Medicine, Bone Marrow Transplantation, Medical University of Vienna, Waehringer, Guertel 18 - 20, A-1090 Vienna, Austria.
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Stussi G, West L, Cooper DKC, Seebach JD. ABO-incompatible allotransplantation as a basis for clinical xenotransplantation. Xenotransplantation 2007; 13:390-9. [PMID: 16925662 DOI: 10.1111/j.1399-3089.2006.00324.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The 8th Congress of the International Xenotransplantation Association (IXA), held in Goteborg in September, 2005, immediately followed the 2nd International Symposium on ABO-Incompatibility in Transplantation, both congresses organized by Michael Breimer and Lennart Rydberg. The Proceedings of the Symposium on ABO-Incompatibility in Transplantation have been published (Xenotransplantation 2006; 13 (2)). The present paper provides an overview of a workshop held at the 8th Congress of the IXA, and highlights the immunological concepts emerging from ABO-incompatible allotransplants and discusses them in relation to xenotransplantation. Using specified immunomodulatory protocols, ABO-incompatible solid organ allotransplantation has become a clinical reality for a small number of patients over the last two decades. ABO-incompatible adult kidney and infant heart transplants have similar patient and graft survivals as their ABO-compatible counterparts. In contrast, ABO-incompatibility is present in up to 30% of all patients receiving hematopoietic stem cell transplants in the absence of specific immunomodulation, without affecting overall survival. Consequently, ABO-incompatible solid organ transplants and hematopoietic stem cell transplants may serve as in vivo models to elucidate the immunological mechanisms of accommodation and/or tolerance in the clinical setting. Because of similarities in the immunological hurdles that need to be overcome, knowledge obtained from ABO-incompatible allotransplantation might further promote advances in the field of xenotransplantation. The similarities and differences between ABO-incompatible allotransplantation and xenotransplantation are discussed.
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Affiliation(s)
- Georg Stussi
- Laboratory for Transplantation Immunology, Department of Internal Medicine, University Hospital Zürich, Zürich, Switzerland
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Stussi G, Halter J, Schanz U, Seebach JD. ABO-histo blood group incompatibility in hematopoietic stem cell and solid organ transplantation. Transfus Apher Sci 2006; 35:59-69. [PMID: 16935028 DOI: 10.1016/j.transci.2006.05.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Accepted: 05/19/2006] [Indexed: 02/01/2023]
Abstract
In contrast to solid organ transplantation (SOT), ABO-histo blood group incompatibility is of minor importance for hematopoietic stem cell transplantation (HSCT). Patients receiving ABO-incompatible HSCT are at an increased risk for immune-mediated hematological complications including immediate and delayed hemolysis, late red blood cell engraftment and pure red cell aplasia, but seem not to have a worse overall survival or increased transplant-related mortality. This review gives an overview of the immunological mechanisms leading to complications associated with ABO-incompatible HSCT and describes approaches to prevent them. The current organ shortage in SOT stimulates the exploration of new strategies to expand the donor pool including ABO-incompatible SOT and xenotransplantation. Here, we discuss the hypothesis that ABO-incompatible transplantation may be viewed as a human in vivo model for the humoral immune mechanisms of antigen-mismatched transplantation. ABO-incompatible HSCT and SOT provide excellent possibilities to analyze graft accommodation and transplantation tolerance. Understanding the underlying mechanisms of graft survival in ABO-incompatible transplantation may facilitate new strategies to overcome the immunological barriers in SOT and xenotransplantation.
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Affiliation(s)
- Georg Stussi
- Department of Internal Medicine, University Hospital, Basel, Switzerland
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