|
|
 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.
 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:
|
|
|
|
 
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]
|
|
|
| |
