Clinical analysis of pure red cell aplasia following major ABO-incompatible allogeneic hematopoletic stem cell transplantation / 中华器官移植杂志

ABSTRACT

Objective To study the incidence,risk factors,clinical outcome,management and prevention of pure red cell aplasia (PRCA) following major ABO-incompatible allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods Forty-two patients underwent major ABO-incompa- tible allo-HSCT,including major ABO-mismatch in 33 patients,major plus minor ABO-mismatch in 9 patients,and 27 recipients with blood group O.Thirteen patients underwent bone marrow transplan- tation,25 peripheral blood stem cell transplantation,and 4 cord blood transplantation.Six patients re- ceived donor-type plasma replacement before transplantation.Cyclosporine A (CsA) and methotrexate (MTX) were used for prophylaxis of graft-versus-host disease (GVHD).Results All 42 patients had sustained engraftment.PRCA occurred in 11/42 patients (26.2%).All the 11 cases of PRCA were in blood group O recipients of grafts from blood group A donor (n=9) or blood group B donor (n= 2);6 patients with blood group O who received donor-type plasma exchange before transplantation did not develop PRCA.PRCA resolved spontaneously in 8 cases with transfusion support.Two patients were treated by donor-type plasma exchange,resulting in the decrease of isoagglutinin titer,followed by complete recovery of erythropoiesis.One patient responded to rituximab and achieved complete re- mission of symptoms of PRCA.Univariate analysis revealed that the most significant risk factors asso- ciated with PRCA were blood group O recipient,blood group A donor,blood group O recipient of graft from blood group A donor;only blood group O/A in recipient/donor pair was identified as being significantly associated with the occurrence of PRCA by multivariate analysis (RR 10.999,95% CI 1.975-61.258,P