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. 2022 Feb 11:13:829670.
doi: 10.3389/fimmu.2022.829670. eCollection 2022.

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

Panpan Zhu  1   2   3   4 , Yibo Wu  1   2   3   4 , Dawei Cui  5 , Jimin Shi  1   2   3   4 , Jian Yu  1   2   3   4 , Yanmin Zhao  1   2   3   4 , Xiaoyu Lai  1   2   3   4 , Lizhen Liu  1   2   3   4 , Jue Xie  5 , He Huang  1   2   3   4 , Yi Luo  1   2   3   4
Affiliations

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

Panpan Zhu et al. Front Immunol. .

Abstract

Background: 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. 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.

Methods: We 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.

Results: None 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).

Keywords: allogeneic hematologic stem cell transplantation; haploidentical donor; isohemagglutinin; major ABO-incompatible transplantation; pure red cell aplasia.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Diagram of patients with ABO-incompatible hematopoietic stem cell transplantation.
Figure 2
Figure 2
Cumulative incidence rates of pure red cell aplasia. Donor type (A), anti-thymocyte globulin (B), Refined Disease Risk Index (C), donor age (D), donor sex (E), and anti-donor isohemagglutinins type (F).
Figure 3
Figure 3
Index of anti-donor isohemagglutinin titer. Pre- HSCT IgG (A), post-HSCT IgG (B), post-HSCT IgM (C), decrease index of IgM after HSCT (D), post-HSCT IgG (E), post-HSCT IgM (F), and decrease index of IgM after HSCT (G).
Figure 4
Figure 4
Transplantation outcome in the cohort. Overall survival (A), disease-free survival (B), relapse rate (C), and non-relapse mortality (D).
See this image and copyright information in PMC

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