Clinical analysis of pure red cell aplasia following major ABO-incompatible allogeneic hematopoletic stem cell transplantation
- VernacularTitle:ABO血型主要不合异基因造血干细胞移植后纯红细胞再生障碍的临床分析
- Author:
Jun-Ping LI
;
Kang-Er ZHU
;
Tao ZHANG
;
- Publication Type:Journal Article
- Keywords:
Red-cell aplasia,pure;
Hematopoietic stem cell transplantation;
ABO blood-group system;
Blood group incompatibility;
Plasima exchange
- From:
Chinese Journal of Organ Transplantation
2005;0(11):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To study the incidence,risk factors,clinical outcome,management and prevention of pure red cell aplasia (PRCA) following major ABO-incompatible allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods Forty-two patients underwent major ABO-incompa- tible allo-HSCT,including major ABO-mismatch in 33 patients,major plus minor ABO-mismatch in 9 patients,and 27 recipients with blood group O.Thirteen patients underwent bone marrow transplan- tation,25 peripheral blood stem cell transplantation,and 4 cord blood transplantation.Six patients re- ceived donor-type plasma replacement before transplantation.Cyclosporine A (CsA) and methotrexate (MTX) were used for prophylaxis of graft-versus-host disease (GVHD).Results All 42 patients had sustained engraftment.PRCA occurred in 11/42 patients (26.2%).All the 11 cases of PRCA were in blood group O recipients of grafts from blood group A donor (n=9) or blood group B donor (n= 2);6 patients with blood group O who received donor-type plasma exchange before transplantation did not develop PRCA.PRCA resolved spontaneously in 8 cases with transfusion support.Two patients were treated by donor-type plasma exchange,resulting in the decrease of isoagglutinin titer,followed by complete recovery of erythropoiesis.One patient responded to rituximab and achieved complete re- mission of symptoms of PRCA.Univariate analysis revealed that the most significant risk factors asso- ciated with PRCA were blood group O recipient,blood group A donor,blood group O recipient of graft from blood group A donor;only blood group O/A in recipient/donor pair was identified as being significantly associated with the occurrence of PRCA by multivariate analysis (RR 10.999,95% CI 1.975-61.258,P
