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. 2021 Jul 9;7(8):e724.
doi: 10.1097/TXD.0000000000001179. eCollection 2021 Aug.

ABO Mismatch in Allogeneic Hematopoietic Stem Cell Transplant: Effect on Short- and Long-term Outcomes

Caterina Giovanna Valentini  1 , Elisabetta Metafuni  1 , Lorenzo Gallo  2 , Sabrina Giammarco  1 , Nicoletta Orlando  1 , Maria Bianchi  1 , Simona Sica  1   2 , Andrea Bacigalupo  1   2 , Patrizia Chiusolo  1   2 , Luciana Teofili  1   2
Affiliations

ABO Mismatch in Allogeneic Hematopoietic Stem Cell Transplant: Effect on Short- and Long-term Outcomes

Caterina Giovanna Valentini et al. Transplant Direct. .

Abstract

Background: The impact of ABO incompatibility (ABO-I) on hematopoietic stem cell transplant outcomes is still debated.

Methods: We retrospectively investigated 432 consecutive transplants performed at our center (2012-2020). All patients but 6 were affected by hematologic malignancies. The effect of different ABO match combinations on engraftment rate, transfusion support, acute and chronic graft-versus-host disease incidences, nonrelapse mortality (NRM), disease-free survival, and overall survival was assessed in univariate and multivariate analysis. Significance was set at P < 0.05.

Results: ABO match distribution among transplants was as follows: 223 ABO-compatible, 94 major ABO-I, 82 minor ABO-I, and 33 bidirectional ABO-I. At univariate analysis, major ABO-I delayed the engraftment of neutrophils, platelets, and erythroid cells. At multivariate analysis, major ABO-I transplants displayed delayed erythroid engraftment (odds ratio [OR], 0.51; 95% confidence intervals [CIs], 0.38-0.70; P < 0.0001) and hindered transfusion independence for both red blood cells (OR, 0.52; 95% CI, 0.37-0.72; P = 0.0001) and platelets (0.60; 95% CI, 0.45-0.86; P = 0.0048). Moreover, major ABO-I transplants received greater amounts of blood products (P < 0.0001 for red blood cells and P = 0.0447 for platelets). In comparison with other ABO matches, major ABO-I was associated with an increased NRM (OR, 1.67; 95% CI, 1.01-2.75; P = 0.0427). No effects of ABO-mismatch were found on graft-versus-host disease, disease-free survival, and overall survival.

Conclusions: Major ABO mismatch delays multilineage engraftment hinders transfusion independence and increases NRM. The prognostic impact of transfusion burden in hematopoietic stem cell transplantation deserves to be explored.

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Conflict of interest statement

The authors declare no conflict of interests.

Figures

None
Graphical abstract
FIGURE 1.
FIGURE 1.
Cumulative incidence of neutrophil, platelet, and reticulocyte engraftment in different ABO match groups.
FIGURE 2.
FIGURE 2.
Cumulative incidence of transfusion discontinuation according to the ABO match. A, Discontinuation of red blood cell and platelet transfusions. B, Transfusion requirements in different ABO match groups. PLT, platelet; RBC, red blood cell.
FIGURE 3.
FIGURE 3.
Nonrelapse mortality, disease-free survival, and overall survival in 432 transplants. A, Comparison among various ABO match combinations. B, Comparison between major ABO-mismatched transplants and other ABO matches merged in 1 single group.
FIGURE 4.
FIGURE 4.
Cumulative incidence of mortality related to relapse, GVHD and infections in 432 transplants. Curves show the comparison between major ABO-mismatched transplants and other ABO matches merged in 1 single group. P values refer to log-rank test. GVHD, graft-vs-host disease.
See this image and copyright information in PMC

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