ABO-incompatible allogeneic hematopoietic stem cell transplantation for treating malignant hematologic diseases / 中国组织工程研究

ABSTRACT

BACKGROUND:ABO-incompatibility between donor and recipient is not a barrier for Successful allogeneic hematopoietic stem cell transplantation even though it is well established that major ABO incompatibility may lead to prolonged destruction of donor-derived erythrocytos and prolonged transfusioil requirements.OBJECTIVE:To explore the effect of ABO.incompatible on clinical characteristics in allogeneic-hematopoietic stem cell transplantation.DESIGN:A retrospective observation.SETTING:Department of Hematology.the Affiliated Drum Tower Hospital of Nanjing University Medical School.PARTICIPANTS:Fourteen patients(11 males and 3 feiliales,aged 15-60 years old)with malignant hematologic diseases who received ABO-incompatible allogeneic hematopoietic stem cell transplantation in the Affiliated Drum Tower Hospital of Nanjing University Medical School from May 2002 to September 2007 Were recruited for this study.Of the 14 patients,7 were human leukocyte antigen(HLA).matched,and the other 7 were HLA-half-matched.Controls were 11 patients who received ABO-compatibility bone marrow transplantation during the same period.Written informed consents for receiving allogeneic hematopoietic stem cell transplantation were obtained from each reciplent.The donors were sibling sister,sibling brother.son and mother,and they all agreed to provide marrow for transplantation.T1lis experiment was given an approval by the Ethics Committees of the hospital.METHODS:Regimen conditioningHLA-matched transplantation regimen conditioning consisted of busulfan(Bu)and cyclophosphamide(Cy).HLA-half-matched transplantation regimen conditioning adopted GIAC program from Beijing People's Hospital.The GIAC program consisted of 4 partsGgranulocyte colony-stimulating factors used for donors;Istronger immunosuppressive regimen conditioning used for recipients;A antihuman thymocyte globulin addedC combined transplantation of bone marrow and peripheral blood;Perfusion of hematopoietic stem cellsThe marrow from ABO-incompatible donor depleted erythrocytes by hydroxyethyl starch sedimentation.MAIN OUTCOME MEASURES:Adverse reaction.complication and hematologic recovery after ABO-incompatibility stem cell transplantation.RESULTS:One out of fourteen recipients developed pure red cell aplasia(PRCA)and dropped out of final analysis.Hematologic recoveryThe median time of erythrocyte recovery after ABO-incompatible stem cell transplantation was delayed compared with ABO compatible stem cell transplantation (t=2.352.P＜0.05).There were no significant difieFences in the recovery of neutrophils and platelets between ABO-incompatible group and ABO-compatible group(P＞0.05).The median time of recovery of the erythrocyte and the blood type switching was delayed in HLA-mis-matched allogeneic hematopoietic stem cell transplantation compared with HLA-matched allogeneic hematopoietic stem cell transplantation,but without significant difference(P＞0.05).ComplicationsDuring the stem cell transfusion following transplantation.none of 14 Patieats had hemolytic complications or delayed haemolysis.CONCLUSION:There was no evidence of ABO-incompatibility between donor and recipient is a barrier for successful allogeneic hematopoietic stem cell transplantation.