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Blood, 1 May 2001, Vol. 97, No. 9, pp. 2580-2586

CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS

Influence of the hematopoietic stem cell source on early immunohematologic reconstitution after allogeneic transplantation

Valérie Lapierre, Nadia Oubouzar, Anne Aupérin, Dominique Tramalloni, Hakim Tayebi, Eric Robinet, Matthieu Kuentz, Didier Blaise, Olivier Hartmann, Patrick Hervé, and Pierre Tiberghien for the Société Française de Greffe de Moelle

From the Unité de Médecine Transfusionnelle et d'Hémovigilance, the Comité de Sécurité Transfusionnelle et d'Hémovigilance, and the Service d'Epidémiologie et de Biostatistique, Institut Gustave Roussy, Villejuif, France; UPRES-EA 2284/Inserm E 0119 Etablissement Français du Sang- Bourgogne/Franche-Comté, Besançon, France; Service d'Hématologie, Hôpital Henri Mondor, Créteil, France; and Unité de Transplantation Médullaire, Institut Paoli Calmettes, Marseille, France.

Several acute hemolysis episodes, sometimes lethal, have been recently described after transplantation of allogeneic peripheral blood hematopoietic stem cells (PBHSCs). Hemolysis resulted from the production of donor-derived antibodies (Abs) directed at ABO antigens (Ags) present on recipient red blood cells (RBCs). A multicenter randomized phase III clinical study comparing allogeneic PBHSC transplantation (PBHSCT) versus bone marrow hematopoietic stem cell transplantation (BMHSCT) has been conducted in France. In the course of this study, serum anti-A and/or anti-B Ab titers were compared before the conditioning regimen and on day +30 after transplantation in 49 consecutive evaluable PBHSCT (n = 21) or BMHSCT (n = 28) recipients. PBHSCT resulted in a higher frequency of increased anti-A and/or anti-B Ab titers 30 days after transplantation as compared to BMHSCT: 8 (38%) of 21 versus 3 (11%) of 28 (P = .04). In PBHSCT recipients, increased titers were observed mostly after receiving a minor ABO mismatch transplant: 5 of 7 versus 3 of 14 in the absence of any minor ABO mismatch (P = .05), whereas this was not the case after BMHSCT: 1 of 8 versus 2 of 20. Anti-A and/or anti-B serum Abs detectable at day +30 after PBHSCT were always directed against A and/or B Ags absent both on donor and recipient RBCs. Finally, 3 of 21 PBHSCT versus 0 of 28 BMHSCT recipients developed anti-allogeneic RBC Abs other than ABO (P = .07). Overall, the data strongly suggest that immunohematologic reconstitution differs significantly after granulocyte colony-stimulating factor-mobilized PBHSCT when compared to BMHSCT. Such a difference could contribute to the acute hemolysis described after PBHSCT as well as to distinct alloreactivity after PBHSCT.

© 2001 by The American Society of Hematology.
 

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V. Lapierre, A. Auperin, H. Tayebi, J. Chabod, P. Saas, M. Michalet, S. Francois, F. Garban, C. Giraud, D. Tramalloni, et al.
Increased presence of anti-HLA antibodies early after allogeneic granulocyte colony-stimulating factor-mobilized peripheral blood hematopoietic stem cell transplantation compared with bone marrow transplantation
Blood, July 30, 2002; 100(4): 1484 - 1489.
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