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Related Collections Transfusion Medicine Transplantation Clinical Trials and Observations Related Letter in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  Blood, 15 September 2001, Vol. 98, No. 6, pp. 1687-1694 CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS Delayed donor red cell chimerism and pure red cell aplasia following major ABO-incompatible nonmyeloablative hematopoietic stem cell transplantation Charles D. Bolan, Susan F. Leitman, Linda M. Griffith, Robert A. Wesley, Jo L. Procter, David F. Stroncek, A. John Barrett, and Richard W. Childs From the Department of Transfusion Medicine, and Biostatistics Branch, Office of the Director, Warren Magnuson Clinical Center, and the Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, and Walter Reed Army Institute of Research, Silver Spring, MD. Delayed donor red cell engraftment and pure red cell aplasia (PRCA) are well-recognized complications of major ABO-incompatible hematopoietic stem cell transplantation (SCT) performed by means of myeloablative conditioning. To evaluate these events following reduced-intensity nonmyeloablative SCT (NST), consecutive series of patients with major ABO incompatibility undergoing either NST (fludarabine/cyclophosphamide conditioning) or myeloablative SCT (cyclophosphamide/high-dose total body irradiation) were compared. Donor red blood cell (RBC) chimerism (initial detection of donor RBCs in peripheral blood) was markedly delayed following NST versus myeloablative SCT (median, 114 versus 40 days; P < .0001) and strongly correlated with decreasing host antidonor isohemagglutinin levels. Antidonor isohemagglutinins declined to clinically insignificant levels more slowly following NST than myeloablative SCT (median, 83 versus 44 days; P = .03). Donor RBC chimerism was delayed more than 100 days in 9 of 14 (64%) and PRCA occurred in 4 of 14 (29%) patients following NST, while neither event occurred in 12 patients following myeloablative SCT. Conversion to full donor myeloid chimerism following NST occurred significantly sooner in cases with, compared with cases without, PRCA (30 versus 98 days; P = .008). Cyclosporine withdrawal appeared to induce graft-mediated immune effects against recipient isohemagglutinin-producing cells, resulting in decreased antidonor isohemagglutinin levels and resolution of PRCA following NST. These data indicate that significantly delayed donor erythropoiesis is (1) common following major ABO-incompatible NST and (2) associated with prolonged persistence of host antidonor isohemagglutinins. The clinical manifestations of these events are affected by the degree and duration of residual host hematopoiesis. © 2001 by The American Society of Hematology.   CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Letter in Blood Online: Outcome of major ABO-incompatible nonmyeloablative hematopoietic stem cell transplantation may be influenced by conditioning regimen Karl S. Peggs, Emma C. Morris, Panos D. Kottaridis, Joanne Geary, Anthony H. Goldstone, David C. Linch, Stephen Mackinnon, Charles D. Bolan, Susan F. Leitman, Linda M. Griffith, A. John Barrett, and Richard W. Childs Blood 2002 99: 4642-4644. [Full Text] [PDF] This article has been cited by other articles: G. Stussi, J. Halter, E. Bucheli, P. V. Valli, L. Seebach, J. Gmur, A. Gratwohl, U. Schanz, J. R. Passweg, and J. D. Seebach 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, February 1, 2009; 94(2): 239 - 248. [Abstract] [Full Text] [PDF] F. Kimura, K. Sato, S. Kobayashi, T. Ikeda, H. Sao, S. Okamoto, K. Miyamura, S. Mori, H. Akiyama, M. Hirokawa, et al. Impact of AB0-blood group incompatibility on the outcome of recipients of bone marrow transplants from unrelated donors in the Japan Marrow Donor Program Haematologica, November 1, 2008; 93(11): 1686 - 1693. [Abstract] [Full Text] [PDF] K. S. Peggs, E. C. Morris, P. D. Kottaridis, J. Geary, A. H. Goldstone, D. C. Linch, S. Mackinnon, C. D. Bolan, S. F. Leitman, L. M. Griffith, et al. Outcome of major ABO-incompatible nonmyeloablative hematopoietic stem cell transplantation may be influenced by conditioning regimen Blood, May 29, 2002; 99(12): 4642 - 4644. [Full Text] [PDF]

	Copyright © 2001 by American Society of Hematology         Online ISSN: 1528-0020