Prevalence of Pure Red Cell Aplasia Following Major ABO-Incompatible Hematopoietic Stem Cell Transplantation.

Panpan Zhu,He Huang,Xiaoyu Lai,Yanmin Zhao,Yi Luo,Jue Xie,Jimin Shi,Dawei Cui,Yibo Wu,Lizhen Liu,Jian Yu

doi:10.3389/fimmu.2022.829670

Abstract

BackgroundPure red cell aplasia (PRCA) is one of the important complications in major ABO-incompatible allogeneic hematopoietic stem cell transplantation (HSCT). The established pathogenic factor of PRCA is the persistence of high anti-donor isohemagglutinins. As previously verified, the conditioning regimen and donor type were the factors associated with the development of PRCA in the small-sized studies. Currently, the prevalence, risk factors, and prognosis of PRCA are still worth studying to provide evidence.MethodsWe conducted a prospective nested case-control study to determine the prevalence, donor-related factors, and the outcomes of PRCA following major ABO-incompatible transplantation. A total of 469 patients who underwent ABO-incompatible grafts were observed.ResultsNone of the patients were diagnosed with PRCA with minor or bidirectional ABO-incompatible HSCT. Thirteen of the187 patients (7%; 95% confidence interval [CI], 3.9%–11.9%) developed PRCA following major ABO-incompatible HSCT. Eleven of the 13 patients with PRCA recovered entirely. Donor type was an independent factor associated with post-HSCT PRCA (odds ratio [OR]=0.030; 95% CI, 0.003–0.321; P=0.004). The cumulative incidence rates of post-HSCT PRCA in the context of major ABO-incompatible HSCT were 0.8%, 13.1%, and 27.2% for the haploidentical donor (HID), unrelated donor, and matched related donor, respectively. No significant influence of PRCA on transplantation outcomes was observed.In conclusion, post-HSCT PRCA is a rare and less threatening complication in major ABO-incompatible HSCT. The majority of patients with PRCA could recover. Additionally, HIDs for recipients may have a low risk of post-HSCT PRCA. This trial was registered at www.chictr.org.cn (#ChiCTR2000041412).

Highlights

ABO-blood group incompatibility occurs in 25% to 50% of human leukocyte antigen-matched hematopoietic stem cell transplantation (HSCT) [1]
It was reported that the persistence of anti-donor isohemagglutinins (ISO) produced by recipient plasma cells may contribute to post-HSCT pure red cell aplasia (PRCA) [6, 10]
The present study is a prospective nested case-control study aiming to determine the prevalence, donor-related factors, and outcome of PRCA following major ABO-incompatible transplantation. It is revealed for the first time that patients undergoing haploidentical donor (HID)-HSCT may be at a lower risk for developing post-HSCT PRCA than those using MSDs or unrelated donors (URDs) in major ABO-incompatible transplantation

Summary

Introduction

ABO-blood group incompatibility occurs in 25% to 50% of human leukocyte antigen-matched hematopoietic stem cell transplantation (HSCT) [1]. It was reported that the persistence of anti-donor isohemagglutinins (ISO) produced by recipient plasma cells may contribute to post-HSCT PRCA [6, 10]. A few patients with a low pre-HSCT isohemagglutinin titer are likely to develop post-HSCT PRCA [11], which may be attributed to the rebound of anti-donor ISO and the post-HSCT transfusion of recipient-type RBC [12–14]. Pure red cell aplasia (PRCA) is one of the important complications in major ABO-incompatible allogeneic hematopoietic stem cell transplantation (HSCT). The established pathogenic factor of PRCA is the persistence of high anti-donor isohemagglutinins. The conditioning regimen and donor type were the factors associated with the development of PRCA in the small-sized studies. The prevalence, risk factors, and prognosis of PRCA are still worth studying to provide evidence

Methods

Results

Conclusion