265: Major ABO blood group mismatch increases the risk for graft failure after unrelated donor hematopoietic stem cell transplantation

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Two hundred and twenty-four patients with leukemia transplanted with an unrelated donor between 1991 and 2003 at Karolinska University Hospital were analyzed according to association between graft failure and ABO, RhD, MNSs and Kidd blood group antigen compatibility. Median age was 29 years (range 0-55).). Two hundred patients and donor pairs were HLA-A, -B, and –DR identical, and 24 patients had an allele-level mismatched donor Conditioning consisted of TBI or busulfan-based myeloablative conditioning. All patients received ATG. A bone marrow graft was given to 152 patients and 72 patients received peripheral blood stem cells. Most patients received GVHD prophylaxis with CsA and MTX.Results: 135 (60%) patients received an ABO mismatched graft and 89 received an ABO matched graft. Of the mismatched grafts, 67 (30%) were major mismatched and 68 (30%) minor mismatched. A bidirectional mismatch was found in 16 (7%) cases. Graft failure (GF) was seen in 6 (2.7%) patients. In the multivariate analysis major ABO mismatch (OR 14.9, 95% CI 2.01-110, p=0.008) and HLA-allele mismatch (6.42, 1.19-34.8, p=0.03) was significantly associated to GF. In patients with and without major ABO mismatch the incidence of GF was 7.5% (5/67) and 0.6% (1/157)(p=0.02), respectively. In patients with and without HLA allele-level mismatch, the incidence of GF was 8.3% (2/24) and 2.0% (4/200)(p=0.09).Conclusion: Using an ABO major mismatched graft increases the risk for graft failure after unrelated donor HSCT. Two hundred and twenty-four patients with leukemia transplanted with an unrelated donor between 1991 and 2003 at Karolinska University Hospital were analyzed according to association between graft failure and ABO, RhD, MNSs and Kidd blood group antigen compatibility. Median age was 29 years (range 0-55).). Two hundred patients and donor pairs were HLA-A, -B, and –DR identical, and 24 patients had an allele-level mismatched donor Conditioning consisted of TBI or busulfan-based myeloablative conditioning. All patients received ATG. A bone marrow graft was given to 152 patients and 72 patients received peripheral blood stem cells. Most patients received GVHD prophylaxis with CsA and MTX. Results: 135 (60%) patients received an ABO mismatched graft and 89 received an ABO matched graft. Of the mismatched grafts, 67 (30%) were major mismatched and 68 (30%) minor mismatched. A bidirectional mismatch was found in 16 (7%) cases. Graft failure (GF) was seen in 6 (2.7%) patients. In the multivariate analysis major ABO mismatch (OR 14.9, 95% CI 2.01-110, p=0.008) and HLA-allele mismatch (6.42, 1.19-34.8, p=0.03) was significantly associated to GF. In patients with and without major ABO mismatch the incidence of GF was 7.5% (5/67) and 0.6% (1/157)(p=0.02), respectively. In patients with and without HLA allele-level mismatch, the incidence of GF was 8.3% (2/24) and 2.0% (4/200)(p=0.09). Conclusion: Using an ABO major mismatched graft increases the risk for graft failure after unrelated donor HSCT.