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Finazzi MC, Weber A, Pavoni C, Grassi A, Micò MC, Algarotti A, Lussana F, Rambaldi A. Rituximab added to conditioning regimen significantly improves erythroid engraftment in major incompatible ABO-group hematopoietic stem cell transplantation. Bone Marrow Transplant 2024; 59:751-758. [PMID: 38402345 PMCID: PMC11161407 DOI: 10.1038/s41409-024-02247-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 02/26/2024]
Abstract
ABO-group major incompatibility hematopoietic stem cell transplantation (HSCT) increases the risk of delayed red cell engraftment and other immunological complications. In this study, we evaluated the efficacy of pre-transplant infusion of rituximab in patients with ABO-incompatibility in improving red blood cell engraftment after HSCT, measured by time to reach transfusion independence. We performed a retrospective, single-center study including 131 consecutive patients transplanted with major or bidirectional ABO-incompatible grafts between 1st January 2013 and 31st December 2019. Fifty-one patients received an infusion of rituximab during the conditioning regimen, while 80 patients did not receive any additional preventive treatment. Time to transfusion independence was significantly reduced for patients treated with rituximab (1 month, 95% CI, 0.5-2) compared with the control group (3.2 months, 95% CI 1.5-3.2, p = 0.02). By multivariable analysis, rituximab use was associated with a faster red blood cell (RBC) engraftment (RR 1.88, 95% CI 1.17-3.03, p = 0.009), while a pre-transplant anti-donor isohemagglutinins titer >1:128 was associated with delayed transfusion independence (RR 0.61, 95% CI 0.37-0.99, p = 0.05). Although limited by the retrospective nature of the study, the results of this analysis suggest that rituximab added to conditioning regimens is feasible, safe, and able to improve post-transplant red blood cell engraftment.
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Affiliation(s)
- Maria Chiara Finazzi
- Department of Oncology and Onco-Hematology, Università degli Studi di Milano, Milano, Italy.
- Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.
| | - Alessandra Weber
- Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Chiara Pavoni
- Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Anna Grassi
- Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Caterina Micò
- Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Alessandra Algarotti
- Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Federico Lussana
- Department of Oncology and Onco-Hematology, Università degli Studi di Milano, Milano, Italy
- Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Alessandro Rambaldi
- Department of Oncology and Onco-Hematology, Università degli Studi di Milano, Milano, Italy
- Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
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2
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Adkins BD, Jacobs JW, Booth GS, Savani BN, Stephens LD. Transfusion Support in Hematopoietic Stem Cell Transplantation: A Contemporary Narrative Review. Clin Hematol Int 2024; 6:128-140. [PMID: 38817704 PMCID: PMC11086996 DOI: 10.46989/001c.94135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/05/2024] [Indexed: 06/01/2024] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is a cornerstone of modern medical practice, and can only be performed safely and effectively with appropriate transfusion medicine support. Patients undergoing HSCT often develop therapy-related cytopenia, necessitating differing blood product requirements in the pre-, peri-, and post-transplant periods. Moreover, ensuring optimal management for patients alloimmunized to human leukocyte antigens (HLA) and/or red blood cell (RBC) antigens, as well as for patients receiving ABO-incompatible transplants, requires close collaboration with transfusion medicine and blood bank professionals. Finally, as updated transfusion guidelines and novel blood product modifications emerge, the options available to the transplant practitioner continue to expand. Herein, we detail contemporary blood transfusion and transfusion medicine practices for patients undergoing HSCT.
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Affiliation(s)
- Brian D. Adkins
- PathologyThe University of Texas Southwestern Medical Center
| | | | - Garrett S. Booth
- Pathology, Microbiology, and ImmunologyVanderbilt University Medical Center
| | - Bipin N. Savani
- Internal Medicine, Division of Hematology/ OncologyVanderbilt University Medical Center
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3
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Vivero A, Peedin AR, Gao Y, Karp JK. Successful treatment of pure red cell aplasia using therapeutic plasma exchange after ABO-incompatible hematopoietic stem cell transplant. J Clin Apher 2023. [PMID: 36703597 DOI: 10.1002/jca.22041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/05/2022] [Accepted: 01/06/2023] [Indexed: 01/28/2023]
Abstract
Hematopoietic stem cell transplants (HSCTs) are widely used in the treatment of hematologic malignancies and bone marrow failure syndromes. ABO compatibility is typically of secondary importance, and up to 50% of HSCT are performed in ABO-incompatible pairings. In the literature, pure red cell aplasia (PRCA) occurs in 1% to 50% of all major/bidirectional ABO-incompatible stem cell transplants, but treatment of PRCA remains heterogeneous. Here, we report two cases in which patients with transfusion-dependent PRCA following HSCT were successfully treated with therapeutic plasma exchange (TPE). Case 1: A 52-year-old type O-positive male with acute myeloid leukemia underwent HSCT using apheresis-derived HSCs from a fully human leukocyte antigen (HLA)-matched, related type A-positive male donor. He developed PRCA that was refractory to multiple therapies, so a series of 10 TPE was performed over 3 weeks. Case 2: A 21-year-old type A-positive male with aplastic anemia underwent HSCT using bone marrow-derived HSCs from a fully HLA-matched related type B-positive female donor. He developed PRCA that was refractory to multiple therapies, so a series of 5 TPE was performed over 2 weeks. Case 1: The patient has been transfusion independent since TPE #7, and type A red blood cells (RBCs) were seen on the ABO type after TPE #9. Case 2: The patient has been transfusion independent since after TPE #1, and type B RBCs were seen on the ABO type after TPE #5. TPE was successful in treating two patients with PRCA after ABO-incompatible HSCT transplants. Isoagglutinin titers decreased below the level of detection for both our patients. Ultimately both patients became transfusion independent and showed evidence of erythroid cell recovery.
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Affiliation(s)
- Angelica Vivero
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Alexis R Peedin
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Yuanzheng Gao
- Department of Pathology, Cooper University Health Care, Camden, New Jersey, USA
| | - Julie Katz Karp
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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4
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Post-Hematopoietic Stem Cell Transplantation Immune-Mediated Anemia: A Literature Review and Novel Therapeutics. Blood Adv 2021; 6:2707-2721. [PMID: 34972204 PMCID: PMC9043947 DOI: 10.1182/bloodadvances.2021006279] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/23/2021] [Indexed: 01/19/2023] Open
Abstract
Anemia after allogeneic hematopoietic stem cell transplantation (HSCT) can be immune or non–immune mediated. Auto- or alloimmunity resulting from blood group incompatibility remains an important cause in post-HSCT immune-mediated anemia. ABO incompatibility is commonly encountered in HSCT and may lead to serious clinical complications, including acute hemolysis, pure red cell aplasia, and passenger lymphocyte syndrome. It remains controversial whether ABO incompatibility may affect HSCT outcomes, such as relapse, nonrelapse mortality, graft-versus-host disease, and survival. Non-ABO incompatibility is less frequently encountered but can have similar complications to ABO incompatibility, causing adverse clinical outcomes. It is crucial to identify the driving etiology of post-HSCT anemia in order to prevent and treat this condition. This requires a comprehensive understanding of the mechanism of anemia in blood group–incompatible HSCT and the temporal association between HSCT and anemia. In this review, we summarize the literature on post-HSCT immune-mediated anemia with a focus on ABO and non-ABO blood group incompatibility, describe the underlying mechanism of anemia, and outline preventive and treatment approaches.
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5
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Mehta P, Ramprakash S, Raghuram CP, Trivedi D, Dhanya R, Agarwal RK, Faulkner L. Pre-transplant donor-type red cell transfusion is a safe and effective strategy to reduce isohemagglutinin titers and prevent donor marrow infusion reactions in major ABO-mismatched transplants. Ann Hematol 2021; 100:2071-2078. [PMID: 34148110 DOI: 10.1007/s00277-021-04571-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 06/04/2021] [Indexed: 11/29/2022]
Abstract
ABO incompatibility is not a barrier to allogeneic stem cell transplant but may result in acute hemolytic reactions. As stem cell product manipulation is cumbersome, we are reporting the effectiveness and safety of donor-type red cell infusion as a method of reducing acute hemolytic reaction while using marrow as stem cell source. In major ABO-mismatched bone marrow transplants, manipulation of marrow product requires expertise and expensive equipment, which may not be readily available to transplant centers in low- and middle-income regions. The aim behind our study is to report a safe and effective strategy to reduce isohemagglutinin titers and prevent donor marrow infusion reactions in major ABO-mismatched transplants. We retrospectively analyzed 303 consecutive allogeneic bone marrow transplants (BMTs) for beta thalassemia major, between August 2015 and March 2020, with either major (n = 41) or bidirectional (n = 14) mismatches. When isohemagglutinin titers were 1:32 or higher, donor-type packed red blood cell was divided into 4 aliquots, irradiated and administered over 4 days at incremental volumes. Patients were observed for hemolytic reaction, and if no reaction, bone marrow was infused without manipulation. Out of 55 patients, 20 received donor-type blood infusion. Twelve patients showed evidence of mild hemolysis. None developed severe hemolytic or anaphylactic reaction. Titers were rechecked in 14 patients and all had reduction in titers, except for one. Our experience demonstrated that donor-type PRBC infusion is safe and effective in preventing acute hemolysis in major ABO-mismatched stem cell transplants even with bone marrow as graft source.
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Affiliation(s)
- Pallavi Mehta
- Sankalp-People tree Paediatric Bone Marrow Transplant Unit, People Tree Hospital, Bangalore, India. .,Hemato-Oncology and Stem Cell Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi, 110085, India.
| | - Stalin Ramprakash
- Sankalp-People tree Paediatric Bone Marrow Transplant Unit, People Tree Hospital, Bangalore, India
| | - C P Raghuram
- Sankalp-People tree Paediatric Bone Marrow Transplant Unit, People Tree Hospital, Bangalore, India
| | - Deepa Trivedi
- Care Institute of Medical Sciences, Sankalp-CIMS Centre for Pediatric BMT, Ahmedabad, India
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6
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Crysandt M, Soysal H, Jennes E, Holtick U, Mrotzek M, Rehnelt S, Holderried TAW, Wessiepe M, Kunter U, Wilop S, Silling G, Gecht J, Beier F, Brümmendorf TH, Jost E. Selective ABO immunoadsorption in hematopoietic stem cell transplantation with major ABO incompatibility. Eur J Haematol 2021; 107:324-332. [PMID: 34022082 DOI: 10.1111/ejh.13668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/15/2021] [Accepted: 05/16/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE ABO mismatch between donor and recipient occurs in 40% of allogeneic hematopoietic stem cell transplantations (HCT). Different strategies have been described to reduce isohemagglutinins (IHA) before HCT. We describe the effect of selective ABO immunoadsorption (ABO IA) on erythrocyte transfusion rate and the development of post-transplant pure red cell aplasia (ptPRCA). METHODS 63 patients with major ABO incompatibility were retrospectively analyzed. Nine patients with major ABO incompatibility and high-IHA titer were treated by ABO IA before HCT. We analyzed the need for transfusion and the occurrence of ptPRCA. We compared the outcome with patients treated by other methods to reduce IHA. RESULTS In all nine patients treated by ABO IA, IHA decreased in a median four times. PtPRCA occurred in one patient. The median number of transfusions was 8 (range: 0-36) between d0 and d100. In 25 patients with high-IHA titer without treatment or treated by other methods to reduce IHA, the need for transfusions was comparable. No difference in the incidence of ptPRCA was observed. CONCLUSIONS Selective ABO IA is a feasible, safe, and effective method to reduce IHA before HCT in major ABO incompatibility. No effect on transfusion rate or ptPRCA compared to other strategies could be observed.
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Affiliation(s)
- Martina Crysandt
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany
| | - Hatice Soysal
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany
| | - Eva Jennes
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Udo Holtick
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany.,Department I of Internal Medicine, Medical Faculty and University Hospital, University of Cologne, Cologne, Germany
| | - Matthias Mrotzek
- Institute of Transfusion Medicine, Medical Faculty and University Hospital, University of Cologne, Cologne, Germany
| | - Susanne Rehnelt
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany.,Department of Oncology, Hematology, Immuno-Oncology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Tobias A W Holderried
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany.,Department of Oncology, Hematology, Immuno-Oncology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Martina Wessiepe
- Division of Transfusion Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Uta Kunter
- Department of Nephrology and Clinical Immunology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Stefan Wilop
- MVZ West GmbH Würselen, Hämatologie-Onkologie, Würselen, Germany
| | - Gerda Silling
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany
| | - Judith Gecht
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany
| | - Fabian Beier
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany
| | - Tim H Brümmendorf
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany
| | - Edgar Jost
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany
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7
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Henig I, Yehudai-Ofir D, Zohar Y, Zuckerman T. Pure Red Cell Aplasia following ABO-Mismatched Allogeneic Hematopoietic Stem Cell Transplantation: Resolution with Daratumumab Treatment. Acta Haematol 2021; 144:683-687. [PMID: 33887733 DOI: 10.1159/000515257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/15/2021] [Indexed: 11/19/2022]
Abstract
Pure red cell aplasia (PRCA) can potentially occur after allogeneic hematopoietic stem cell transplantation (allo-HSCT) if recipient and donor ABO blood groups are mismatched, with the recipient having isoagglutinins against the donor blood group. Patient plasma cells that survive transplant conditioning produce anti-ABO isoagglutinins targeting donor erythroid precursors in the bone marrow and thus causing red cell aplasia. Therapeutic options include steroids, discontinuation of immunosuppression, plasmapheresis, donor lymphocyte infusion, rituximab, and bortezomib, all with limited benefit. Daratumumab utilized in the treatment of multiple myeloma is an anti-CD38 monoclonal antibody targeting plasma cells, which makes it a potentially efficient therapy for PRCA. The current case report presents a patient with post-allo-HSCT PRCA cured with daratumumab applied after failure of other therapies. Our findings demonstrate safety and high efficiency of daratumumab, suggesting its applicability as early treatment of post-allo-HSCT PRCA.
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Affiliation(s)
- Israel Henig
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Dana Yehudai-Ofir
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Yaniv Zohar
- Department of Pathology, Rambam Health Care Campus, Haifa, Israel
| | - Tsila Zuckerman
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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8
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Longval T, Galimard JE, Leprêtre AC, Suarez F, Amiranoff D, Cazaux M, Kaphan E, Michonneau D, Dhedin N, Coman T, Nguyen Quoc S, Peffault de Latour R, Resche-Rigon M, Sicre de Fontbrune F. Treatment for pure red cell aplasia after major ABO-incompatible allogeneic stem cell transplantation: a multicentre study. Br J Haematol 2021; 193:814-826. [PMID: 33844842 DOI: 10.1111/bjh.17463] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/12/2021] [Indexed: 11/30/2022]
Abstract
Pure red cell aplasia (PRCA) following allogeneic haematopoietic stem cell transplantation (aHSCT) with major ABO incompatibility is responsible for transfusion dependent anaemia, impaired quality of life and iron overload. We conducted a retrospective study, over a 10-year period, which included all consecutive patients who received a major ABO mismatched aHSCT, to assess the impact of specific treatment on PRCA. We did not observe any PRCA in the 57 aHSCT issued from cord blood. Among the remaining 631 patients, cumulative incidence of PRCA was 10·5% [range 8·2-13.0]. The median duration of resolved PRCA was 171 days [IQR 116; 261]. Pre-transplant high isohaemagglutinins titre was associated with an increased risk of PRCA (P < 10-4 ). PRCA did not affect overall survival (P = 0·95). Twenty-two patients (33·3%) received at least one specific treatment. The most commonly used treatments were rituximab (17 patients) and donor lymphocyte infusion (DLI; seven patients). Regarding PRCA resolution, we did not observe a significant difference between treated or untreated subjects (HR = 0·93, 95% confidence interval (CI) 0·48- 1·80; P = 0·82). Similar results were observed with erythropoietin treatment (22 patients, HR = 0·86 95% CI: [0·47-1·57] P = 0·62). Our data do not support the use of erythropoietin, rituximab or DLI for the treatment of PRCA.
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Affiliation(s)
- Thomas Longval
- Haematology Transplant Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Jacques-Emmanuel Galimard
- Centre of Research in Epidemiology and Statistics, Sorbonne Paris Cité, INSERM, UMR-1153, ECSTRRA Team, Paris, France
| | | | - Felipe Suarez
- Adult Haematology Department, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Denise Amiranoff
- Établissement Français du Sang (EFS), Necker-Enfants Malades Hospital, Paris, France
| | - Marine Cazaux
- Haematology Transplant Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Eleonore Kaphan
- Haematology Transplant Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - David Michonneau
- Haematology Transplant Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Nathalie Dhedin
- Haematology Transplant Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Tereza Coman
- Haematology Department, Gustave-Roussy, Villejuif, France
| | | | - Régis Peffault de Latour
- Haematology Transplant Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Matthieu Resche-Rigon
- Centre of Research in Epidemiology and Statistics, Sorbonne Paris Cité, INSERM, UMR-1153, ECSTRRA Team, Paris, France.,Biostatistics Unit, SBIM, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Flore Sicre de Fontbrune
- Haematology Transplant Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
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9
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Stubbs J, Klompas A, Thalji L. Transfusion Therapy in Specific Clinical Situations. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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10
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ABO incompatibile graft management in pediatric transplantation. Bone Marrow Transplant 2020; 56:84-90. [PMID: 32594103 DOI: 10.1038/s41409-020-0981-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 03/28/2020] [Accepted: 06/12/2020] [Indexed: 11/09/2022]
Abstract
Up to 40% of donor-recipient pairs in SCT have some degree of ABO incompatibility, which may cause severe complications. The aim of this study was to describe available options and survey current practices by means of a questionnaire circulated within the EBMT Pediatric Diseases Working Party investigators. Major ABO incompatibility (donor's RBCs have antigens missing on the recipient's cell surface, towards which the recipient has circulating isohemagglutinins) requires most frequently an intervention in case of bone marrow grafts, as immediate or delayed hemolysis, delayed erythropoiesis and pure red cell aplasia may occur. RBC depletion from the graft (82%), recipient plasma-exchange (14%) were the most common practices, according to the survey. Graft manipulation is rarely needed in mobilized peripheral blood grafts. In case of minor incompatible grafts (donor has isohemagglutinins directed against recipient RBC antigens), isohemagglutinin depletion from the graft by plasma reduction/centrifugation may be considered, but acute tolerability of minor incompatible grafts is rarely an issue. According to the survey, minor ABO incompatibility was either managed by means of plasma removal from the graft, especially when isohemagglutinin titer was above a certain threshold, or led to no intervention at all (41%). Advantages and disadvantages of each method are discussed.
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11
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Shim H, Hwang J, Kang S, Seo H, Park EY, Park KU, Kong S. Comparison of ABO isoagglutinin titres by three different methods: tube haemagglutination, micro‐column agglutination and automated immunohematology analyzer based on erythrocyte‐magnetized technology. Vox Sang 2020; 115:233-240. [DOI: 10.1111/vox.12878] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/16/2019] [Accepted: 12/01/2019] [Indexed: 01/30/2023]
Affiliation(s)
- Hyoeun Shim
- Department of Laboratory Medicine National Cancer Center Goyang Korea
| | - Joo‐Hyung Hwang
- Department of Laboratory Medicine National Cancer Center Goyang Korea
| | - Su‐jin Kang
- Department of Laboratory Medicine National Cancer Center Goyang Korea
| | - Hee‐Seoung Seo
- Department of Laboratory Medicine National Cancer Center Goyang Korea
| | - Eun Young Park
- Biostatistics Collaboration Team, Research Institute National Cancer Center Goyang Korea
| | - Kyoung Un Park
- Department of Laboratory Medicine Seoul National University Bundang Hospital Seongnam Korea
| | - Sun‐Young Kong
- Department of Laboratory Medicine National Cancer Center Goyang Korea
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12
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Padmanabhan A, Connelly-Smith L, Aqui N, Balogun RA, Klingel R, Meyer E, Pham HP, Schneiderman J, Witt V, Wu Y, Zantek ND, Dunbar NM, Schwartz GEJ. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice - Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue. J Clin Apher 2019; 34:171-354. [PMID: 31180581 DOI: 10.1002/jca.21705] [Citation(s) in RCA: 784] [Impact Index Per Article: 156.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating and categorizing indications for the evidence-based use of therapeutic apheresis (TA) in human disease. Since the 2007 JCA Special Issue (Fourth Edition), the committee has incorporated systematic review and evidence-based approaches in the grading and categorization of apheresis indications. This Eighth Edition of the JCA Special Issue continues to maintain this methodology and rigor in order to make recommendations on the use of apheresis in a wide variety of diseases/conditions. The JCA Eighth Edition, like its predecessor, continues to apply the category and grading system definitions in fact sheets. The general layout and concept of a fact sheet that was introduced in the Fourth Edition, has largely been maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of TA in a specific disease entity or medical condition. The Eighth Edition comprises 84 fact sheets for relevant diseases and medical conditions, with 157 graded and categorized indications and/or TA modalities. The Eighth Edition of the JCA Special Issue seeks to continue to serve as a key resource that guides the utilization of TA in the treatment of human disease.
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Affiliation(s)
- Anand Padmanabhan
- Medical Sciences Institute & Blood Research Institute, Versiti & Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Laura Connelly-Smith
- Department of Medicine, Seattle Cancer Care Alliance & University of Washington, Seattle, Washington
| | - Nicole Aqui
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rasheed A Balogun
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Reinhard Klingel
- Apheresis Research Institute, Cologne, Germany & First Department of Internal Medicine, University of Mainz, Mainz, Germany
| | - Erin Meyer
- Department of Hematology/Oncology/BMT/Pathology, Nationwide Children's Hospital, Columbus, Ohio
| | - Huy P Pham
- Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Jennifer Schneiderman
- Department of Pediatric Hematology/Oncology/Neuro-oncology/Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois
| | - Volker Witt
- Department for Pediatrics, St. Anna Kinderspital, Medical University of Vienna, Vienna, Austria
| | - Yanyun Wu
- Bloodworks NW & Department of Laboratory Medicine, University of Washington, Seattle, Washington, Yale University School of Medicine, New Haven, Connecticut
| | - Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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13
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Pham HP, Staley EM, Schwartz J. Therapeutic plasma exchange – A brief review of indications, urgency, schedule, and technical aspects. Transfus Apher Sci 2019; 58:237-246. [DOI: 10.1016/j.transci.2019.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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14
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Figueiredo TWB, Mercês NNAD, Silva LAAD, Machado CAM. PROTOCOL OF NURSING CARE ON ZERO DAY OF THE TRANSPLANTATION OF HEMATOPOETIC STEM CELLS: COLLECTIVE CONSTRUCTION. TEXTO & CONTEXTO ENFERMAGEM 2019. [DOI: 10.1590/1980-265x-tce-2018-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to construct a protocol of nursing care to the patient on day zero of hematopoietic stem cell transplantation. Method: a convergent care research was developed from August to December 2016 in a Bone Marrow Transplant Service. The participants were twenty-two nurses from this service. The technique of data collection used was discussion groups. For the analysis the following steps were taken: transcription of the data, highlighting the suggestions of the participants; distribution of contributions by theme, for synthesis of the elements in a coherent whole, scientific evidence and contributions of the participants; and construction of the protocol, with refinement and approval of the final version by nurses. Results: the protocol, guides nursing care to be provided by the nurse on day zero of hematopoietic stem cell transplantation, according to the infusion mode: fresh and cryopreserved-thawed. These precautions aim to prevent, identify and intervene early in complications related to cell infusion. Conclusion: the protocol, product of the research, was elaborated in the union of scientific evidences, with the reality of the service and the experience of the participating nurses. The utilization of the methodological steps of convergent care research was a facilitator, because, as it presupposes, it provided the union of care practice with scientific research. The participation of nurses in the construction and approval of the protocol enabled the subsequent implementation and use of this tool in nursing service.
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15
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Quek J, Lee JJ, Lim FL, Diong C, Goh YT, Gopalakrishnan S, Ho A, Hwang W, Koh M, Loh Y, Linn YC. Donor-type fresh frozen plasma is effective in preventing hemolytic reaction in major ABO incompatible allogeneic stem cell transplant. Transfusion 2018; 59:335-339. [PMID: 30467850 DOI: 10.1111/trf.15053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 08/26/2018] [Accepted: 08/28/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hemolysis at the time of graft infusion is one of the immediate complications in major ABO-incompatible allogeneic hematopoietic stem cell transplants (HSCTs). We conducted a retrospective analysis to evaluate the efficacy of donor-type fresh frozen plasma (FFP) in reducing isohemagglutinin titer and preventing hemolysis, as well as its effect on delayed red cell engraftment. MATERIALS AND METHODS This is a single-center study on a series of 380 allogeneic HSCT between 2005 and 2015; of which 99 were either major (n = 74) or bidirectional (n = 25) ABO mismatched. Pre-transplant infusion of FFP, post-transplant complications and transfusion requirements were determined by retrospective review of individual medical records. Laboratory results were also reviewed for evidence of hemolysis and pure red cell aplasia (PRCA). RESULTS Clinical manifestation of hemolysis attributable to ABO mismatch was present in one recipient of major ABO-incompatible peripheral blood stem cell (PBSC) with a titer of 64. Another recipient of major ABO-incompatible PBSC with a titer of 64 showed biochemical evidence of hemolysis. Both patients recovered with supportive treatment. Hemolysis did not occur in any patients with titer of 32 or less at the time of stem cell infusion. We were unable to demonstrate the influence of any variables on the incidence of PRCA. CONCLUSION Our experience demonstrated that donor-type FFP is safe and effective in preventing acute hemolysis in major ABO-mismatched HSCT. We have also established the titer of 64 as the threshold that may cause hemolysis and therefore efforts should be made to reduce titer to below this level.
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Affiliation(s)
- Jeffrey Quek
- Department of Hematology, Singapore General Hospital, Singapore
| | - Jing Jing Lee
- Department of Hematology, Singapore General Hospital, Singapore
| | | | - Colin Diong
- Department of Hematology, Singapore General Hospital, Singapore
| | - Yeow Tee Goh
- Department of Hematology, Singapore General Hospital, Singapore
| | | | - Aloysius Ho
- Department of Hematology, Singapore General Hospital, Singapore
| | - William Hwang
- Department of Hematology, Singapore General Hospital, Singapore
| | - Mickey Koh
- Blood Service Group, Health Science Authority, Singapore
| | - Yvonne Loh
- Department of Hematology, Singapore General Hospital, Singapore
| | - Yeh Ching Linn
- Department of Hematology, Singapore General Hospital, Singapore
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16
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Sackett K, Cohn CS, Fahey-Ahrndt K, Smith AR, Johnson AD. Successful treatment of pure red cell aplasia because of ABO major mismatched stem cell transplant. J Clin Apher 2017; 33:108-112. [DOI: 10.1002/jca.21553] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 12/12/2016] [Accepted: 04/21/2017] [Indexed: 01/03/2023]
Affiliation(s)
- Katie Sackett
- Departments of Laboratory Medicine and Pathology and Pediatrics Blood and Marrow Transplantation; University of Minnesota; Minneapolis Minnesota
| | - Claudia S. Cohn
- Departments of Laboratory Medicine and Pathology and Pediatrics Blood and Marrow Transplantation; University of Minnesota; Minneapolis Minnesota
| | - Kayla Fahey-Ahrndt
- Departments of Laboratory Medicine and Pathology and Pediatrics Blood and Marrow Transplantation; University of Minnesota; Minneapolis Minnesota
| | - Angela R. Smith
- Departments of Laboratory Medicine and Pathology and Pediatrics Blood and Marrow Transplantation; University of Minnesota; Minneapolis Minnesota
| | - Andrew D. Johnson
- Departments of Laboratory Medicine and Pathology and Pediatrics Blood and Marrow Transplantation; University of Minnesota; Minneapolis Minnesota
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17
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Schwartz J, Padmanabhan A, Aqui N, Balogun RA, Connelly-Smith L, Delaney M, Dunbar NM, Witt V, Wu Y, Shaz BH. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice-Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Seventh Special Issue. J Clin Apher 2017; 31:149-62. [PMID: 27322218 DOI: 10.1002/jca.21470] [Citation(s) in RCA: 276] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating, and categorizing indications for the evidence-based use of therapeutic apheresis in human disease. Since the 2007 JCA Special Issue (Fourth Edition), the Committee has incorporated systematic review and evidence-based approaches in the grading and categorization of apheresis indications. This Seventh Edition of the JCA Special Issue continues to maintain this methodology and rigor to make recommendations on the use of apheresis in a wide variety of diseases/conditions. The JCA Seventh Edition, like its predecessor, has consistently applied the category and grading system definitions in the fact sheets. The general layout and concept of a fact sheet that was used since the fourth edition has largely been maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of therapeutic apheresis in a specific disease entity. The Seventh Edition discusses 87 fact sheets (14 new fact sheets since the Sixth Edition) for therapeutic apheresis diseases and medical conditions, with 179 indications, which are separately graded and categorized within the listed fact sheets. Several diseases that are Category IV which have been described in detail in previous editions and do not have significant new evidence since the last publication are summarized in a separate table. The Seventh Edition of the JCA Special Issue serves as a key resource that guides the utilization of therapeutic apheresis in the treatment of human disease. J. Clin. Apheresis 31:149-162, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Joseph Schwartz
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
| | - Anand Padmanabhan
- Blood Center of Wisconsin, Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nicole Aqui
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rasheed A Balogun
- Division of Nephrology, University of Virginia, Charlottesville, Virginia
| | - Laura Connelly-Smith
- Department of Medicine, Seattle Cancer Care Alliance and University of Washington, Seattle, Washington
| | - Meghan Delaney
- Bloodworks Northwest, Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Volker Witt
- Department for Pediatrics, St. Anna Kinderspital, Medical University of Vienna, Vienna, Austria
| | - Yanyun Wu
- Bloodworks Northwest, Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Beth H Shaz
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York.,New York Blood Center, Department of Pathology.,Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
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18
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De Santis GC, Garcia-Silva AC, Dotoli GM, de Castro PT, Simões BP, Covas DT. Higher Anti-A/B isoagglutinin titers of IgG class, but not of IgM, are associated with increased red blood cell transfusion requirements in bone marrow transplantation with major ABO-mismatch. Clin Transplant 2017; 31. [DOI: 10.1111/ctr.12913] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Gil Cunha De Santis
- Internal Medicine; Center for Cell-Based Therapy of Ribeirão Preto; University of São Paulo; Ribeirão Preto São Paulo Brazil
| | - Aline Cristina Garcia-Silva
- Internal Medicine; Center for Cell-Based Therapy of Ribeirão Preto; University of São Paulo; Ribeirão Preto São Paulo Brazil
| | - Giuliana Martinelli Dotoli
- Internal Medicine; Center for Cell-Based Therapy of Ribeirão Preto; University of São Paulo; Ribeirão Preto São Paulo Brazil
| | - Pamela Tinti de Castro
- Internal Medicine; Center for Cell-Based Therapy of Ribeirão Preto; University of São Paulo; Ribeirão Preto São Paulo Brazil
| | - Belinda Pinto Simões
- Internal Medicine; Ribeirão Preto School of Medicine; University of São Paulo; Ribeirão Preto São Paulo Brazil
| | - Dimas Tadeu Covas
- Internal Medicine; Ribeirão Preto School of Medicine; University of São Paulo; Ribeirão Preto São Paulo Brazil
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Transfusion Therapy in Specific Clinical Situations. Transfus Med 2016. [DOI: 10.1002/9781119236504.ch12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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20
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Acute Disseminated Encephalomyelitis. J Clin Apher 2016; 31:163-202. [PMID: 27322219 DOI: 10.1002/jca.21474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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21
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Staley EM, Schwartz J, Pham HP. An update on ABO incompatible hematopoietic progenitor cell transplantation. Transfus Apher Sci 2016; 54:337-44. [PMID: 27211814 DOI: 10.1016/j.transci.2016.05.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Hematopoietic progenitor cell (HPC) transplantation has long been established as the optimal treatment for many hematologic malignancies. In the setting of allogenic HLA matched HPC transplantation, greater than 50% of unrelated donors and 30% of related donors demonstrate some degree of ABO incompatibility (ABOi), which is classified in one of three ways: major, minor, or bidirectional. Major ABOi refers to the presence of recipient isoagglutinins against the donor's A and/or B antigen. Minor ABOi occurs when the HPC product contains the isoagglutinins targeting the recipient's A and/or B antigen. Bidirectional refers to the presence of both major and minor ABOi. Major adverse events associated with ABOi HPC transplantation includes acute and delayed hemolysis, pure red cell aplasia, and delayed engraftment. ABOi HPC transplantation poses a unique challenge to the clinical transplantation unit, the HPC processing lab, and the transfusion medicine service. Therefore, it is essential that these services actively communicate with one another to ensure patient safety. This review will attempt to globally address the challenges related to ABOi HPC transplantation, with an increased focus on aspects related to the laboratory and transfusion medicine services.
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Affiliation(s)
- Elizabeth M Staley
- Department of Pathology, Division of Laboratory Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joseph Schwartz
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York-Presbyterian Hospital, New York, NY, USA
| | - Huy P Pham
- Department of Pathology, Division of Laboratory Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
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22
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Abstract
BACKGROUND Patients receiving hematopoietic stem cell transplantation require extensive transfusion support until red blood cell and platelet engraftment occurs. Rare but predictable complications may arise when the transplanted stem cells are incompatible with the native ABO type of the patient. Immediate and delayed hemolysis is often seen. METHODS A literature review was performed and the results from peer-reviewed papers that contained reproducible findings were integrated. RESULTS A strong body of clinical evidence has developed around the common complications experienced with ABO-incompatible hematopoietic stem cell transplantation. These complications are discussed and the underlying pathophysiology is explained. General treatment options and guidelines are enumerated. CONCLUSIONS ABO-incompatible hematopoietic stem cell transplantations are frequently performed. Immune-related hemolysis is a commonly encountered complication; therefore, health care professionals must recognize the signs of immune-mediated hemolysis and understand the various etiologies that may drive the process.
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Affiliation(s)
- Claudia S Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, 55455, USA.
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23
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24
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Patrick K, Lau W, Gassas A, McDougall E, Doyle J, Ali M, Krueger J, Courtney S, Armstrong C, Egeler RM, Schechter T. Major ABO incompatible BMT in children: determining what residual volume of donor red cells can safely be infused following red cell depletion. Bone Marrow Transplant 2015; 50:536-9. [PMID: 25621802 DOI: 10.1038/bmt.2014.309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 11/03/2014] [Accepted: 11/25/2014] [Indexed: 11/09/2022]
Abstract
Major ABO incompatible BM transplantation carries a risk of acute haemolysis. Red cell depletion reduces this risk but not all incompatible RBC (iRBCs) are removed and in children the residual volume can be significant relative to body weight. We sought to determine the volume of iRBCs that can be safely given to children. All patients receiving fresh BM from a donor with a major ABO blood group mismatch between January 2000 and July 2013 at the Hospital for Sick Children, Toronto, were included. Seventy-eight patients were identified. The median volume of iRBCs transfused was 1.6 mL/kg (range 0.1-10.6 mL/kg). Thirty-five patients had minor haemolytic events and five patients had clinically significant adverse events. Two patients, who received 3.66 and 3.9 mL iRBCs/kg, developed renal impairment and in one case hypoxia and hyperbilirubinaemia. One patient had mild hypotension that resolved with i.v. fluid. Two patients developed hypotension secondary to sepsis and unrelated to BM infusion. Although signs of haemolysis occur, with appropriate hydration and monitoring of renal function, clinically significant adverse events related to the infusion of ABO incompatible BM are rare, and, in this study, were only seen in patients receiving >3 mL/kg of iRBCs per kg.
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Affiliation(s)
- K Patrick
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - W Lau
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - A Gassas
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - E McDougall
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - J Doyle
- Division of Paediatric Haematology/Oncology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - M Ali
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - J Krueger
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - S Courtney
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - C Armstrong
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - R M Egeler
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - T Schechter
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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25
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Holbro A, Passweg JR. Management of hemolytic anemia following allogeneic stem cell transplantation. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2015; 2015:378-384. [PMID: 26637746 DOI: 10.1182/asheducation-2015.1.378] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Hemolytic anemia (HA) is a frequent condition with variable pathophysiology. Hematopoietic stem cell transplantation (HSCT) is unique because it is performed across the ABO blood group barrier. Thereby, there is a transfer of plasma, red blood cells, and immunocompetent cells from the donor to the recipient, possibly leading to HA, due to red blood cell incompatibility. The underlying disease, drugs (particularly those used for conditioning and immunosuppressants), infections, graft-versus-host disease, and autoimmune diseases may all contribute to the clinical and laboratory picture of HA. Additionally, transplantation-associated thrombotic microangiopathy (TA-TMA) may occur and is associated with significant morbidity and mortality. This review highlights the current knowledge on HA after allogeneic HSCT, particularly due to ABO incompatibility. We follow the timeline of the transplantation process and discuss investigations, differential diagnosis, and prophylactic measures including graft processing to avoid hemolysis in case of ABO incompatibility. Finally, current therapeutic approaches for both TA-TMA and post-HSCT autoimmune HA, which are associated with high morbidity and mortality, are discussed.
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Affiliation(s)
- Andreas Holbro
- Division of Hematology, Department of Internal Medicine, University Hospital, Basel, Switzerland; and Blood Transfusion Centre, Swiss Red Cross, Basel, Switzerland
| | - Jakob R Passweg
- Division of Hematology, Department of Internal Medicine, University Hospital, Basel, Switzerland; and
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26
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Sheppard D, Huebsch LB, Bredeson C. What is the optimal approach to major ABO-incompatible allogeneic stem cell transplantation? Biol Blood Marrow Transplant 2013; 19:1760. [PMID: 24120381 DOI: 10.1016/j.bbmt.2013.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 09/27/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Dawn Sheppard
- Department of Haematology, The Ottawa Hospital, Ottawa, Ontario, Canada.
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27
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Booth GS, Gehrie EA, Bolan CD, Savani BN. Clinical Guide to ABO-Incompatible Allogeneic Stem Cell Transplantation. Biol Blood Marrow Transplant 2013; 19:1152-8. [DOI: 10.1016/j.bbmt.2013.03.018] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 03/30/2013] [Indexed: 11/29/2022]
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