Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Worel, N; Greinix, HT; Supper, V; Leitner, G; Mitterbauer, M; Rabitsch, W; Fischer, G; Rosenmayr, A; Höcker, P; Kalhs, P.
Prophylactic red blood cell exchange for prevention of severe immune hemolysis in minor ABO-mismatched allogeneic peripheral blood progenitor cell transplantation after reduced-intensity conditioning.
Transfusion. 2007; 47(8): 1494-1502.
Doi: 10.1111/j.1537-2995.2007.01289.x
Web of Science
PubMed
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- Co-Autor*innen der Med Uni Graz
- Greinix Hildegard
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- Abstract:
- Delayed severe immune hemolysis due to donor-derived passenger lymphocytes is observed in minor and/or bidirectional ABO-mismatched transplants, especially after reduced-intensity conditioning (RIC). The incidence is reported in up to 30 percent of patients and can result in multiorgan failure (MOF) and death. A first group of 32 patients (historical control) underwent RIC followed by allogeneic hematopoietic peripheral blood progenitor cell transplantation at our institution. In 5 of 10 patients with a minor and/or bidirectional ABO-mismatched graft, severe immune hemolysis was observed, leading to death in 3 of them. Therefore, we initiated a protocol with prophylactic red blood cell (RBC) exchange in minor and/or bidirectional ABO mismatch of a second group of patients (study group) and investigated the incidence of hemolysis, transplant-related mortality (TRM), and overall survival (OS) and compared these data with the historical control group. Twenty-two of 80 patients in the study group had a minor and/or bidirectional ABO-mismatched donor. In 20 patients, a prophylactic RBC exchange was performed. Three patients showed mild to moderate citrate reactions, and in 1 patient the procedure had to be stopped because of hypotension. Eighteen of 20 patients engrafted uneventfully, 1 patient rejected his graft, and another 1 showed signs of mild hemolysis. In the minor and/or bidirectional ABO-mismatched setting patients in the study group had a lower risk for TRM at 1 year compared to patients in the historical control group (16% vs. 53%, p < 0.05) and a better 1-year OS (65% vs. 40%, p < 0.05). RBC exchange is a safe procedure, reducing the incidence of delayed severe immune hemolysis and thus the risk of TRM in minor and/or bidirectional ABO-mismatched cases.
- Find related publications in this database (using NLM MeSH Indexing)
- ABO Blood-Group System - immunology
- Adolescent -
- Adult -
- Aged -
- Blood Group Incompatibility - blood
- Erythrocyte Transfusion -
- Exchange Transfusion, Whole Blood -
- Female -
- Graft vs Host Disease - etiology
- Hemolysis -
- Humans -
- Male -
- Middle Aged -
- Peripheral Blood Stem Cell Transplantation - adverse effects Peripheral Blood Stem Cell Transplantation - mortality
- Transplantation Conditioning - methods
- Transplantation, Homologous -