. 2025 Mar;104(3):1931-1947.

doi: 10.1007/s00277-025-06213-4. Epub 2025 Mar 19.

Effect of major ABO blood group mismatched HSCT on blood transfusion and clinical outcomes in AA patients

Dongdi Lai^{1

2

3

4}, Dandan Chen^{1

5

4}, Xiaowei Chen^{1

6

4}, Ruiqing Zhou^{1

6

4}, Minglu Zhong^{1

2

3

4}, Xiaojie Chen^{1

2

3

4}, Jianyun Huang^{1

2

3

4}, Yanfei Lan^{1

2

3

4}, Xinxin Tong^{1

2

3

4}, Zhen Liu^{1

2

3

4}, Xuexin Yang^{1

2

3

4}, Shunqing Wang^{7

8

9}, Yaming Wei^{10

11

12

13}, Zhaohu Yuan^{14

15

16

17}

Affiliations

¹ Department of Blood Transfusion, School of Medicine, The Second Affiliated Hospital, South China University of Technology, Guangzhou, 510180, China.
² Department of Blood Transfusion, Guangzhou First Peoples Hospital, Guangzhou, 510180, China.
³ Guangdong Engineering Research Centre of Precise Transfusion, Guangzhou, 510180, China.
⁴ Institute of Blood Transfusion and Hematology, Guangzhou Medical University, Guangzhou, China.
⁵ Department of Radiology, Guangzhou First Peoples Hospital, Guangzhou, 510180, Guangdong, China.
⁶ Department of Haematology, Guangzhou First People's Hospital, Guangzhou, 510180, China.
⁷ Department of Blood Transfusion, School of Medicine, The Second Affiliated Hospital, South China University of Technology, Guangzhou, 510180, China. shqwang_cn@163.com.
⁸ Department of Haematology, Guangzhou First People's Hospital, Guangzhou, 510180, China. shqwang_cn@163.com.
⁹ Institute of Blood Transfusion and Hematology, Guangzhou Medical University, Guangzhou, China. shqwang_cn@163.com.
¹⁰ Department of Blood Transfusion, School of Medicine, The Second Affiliated Hospital, South China University of Technology, Guangzhou, 510180, China. eywym@scut.edu.cn.
¹¹ Department of Blood Transfusion, Guangzhou First Peoples Hospital, Guangzhou, 510180, China. eywym@scut.edu.cn.
¹² Guangdong Engineering Research Centre of Precise Transfusion, Guangzhou, 510180, China. eywym@scut.edu.cn.
¹³ Institute of Blood Transfusion and Hematology, Guangzhou Medical University, Guangzhou, China. eywym@scut.edu.cn.
¹⁴ Department of Blood Transfusion, School of Medicine, The Second Affiliated Hospital, South China University of Technology, Guangzhou, 510180, China. eyyuanzhaohu@scut.edu.cn.
¹⁵ Department of Blood Transfusion, Guangzhou First Peoples Hospital, Guangzhou, 510180, China. eyyuanzhaohu@scut.edu.cn.
¹⁶ Guangdong Engineering Research Centre of Precise Transfusion, Guangzhou, 510180, China. eyyuanzhaohu@scut.edu.cn.
¹⁷ Institute of Blood Transfusion and Hematology, Guangzhou Medical University, Guangzhou, China. eyyuanzhaohu@scut.edu.cn.

PMID: 40102306
PMCID: PMC12031907
DOI: 10.1007/s00277-025-06213-4

Effect of major ABO blood group mismatched HSCT on blood transfusion and clinical outcomes in AA patients

Dongdi Lai et al. Ann Hematol. 2025 Mar.

. 2025 Mar;104(3):1931-1947.

doi: 10.1007/s00277-025-06213-4. Epub 2025 Mar 19.

Authors

Affiliations

¹ Department of Blood Transfusion, School of Medicine, The Second Affiliated Hospital, South China University of Technology, Guangzhou, 510180, China.
² Department of Blood Transfusion, Guangzhou First Peoples Hospital, Guangzhou, 510180, China.
³ Guangdong Engineering Research Centre of Precise Transfusion, Guangzhou, 510180, China.
⁴ Institute of Blood Transfusion and Hematology, Guangzhou Medical University, Guangzhou, China.
⁵ Department of Radiology, Guangzhou First Peoples Hospital, Guangzhou, 510180, Guangdong, China.
⁶ Department of Haematology, Guangzhou First People's Hospital, Guangzhou, 510180, China.
⁷ Department of Blood Transfusion, School of Medicine, The Second Affiliated Hospital, South China University of Technology, Guangzhou, 510180, China. shqwang_cn@163.com.
⁸ Department of Haematology, Guangzhou First People's Hospital, Guangzhou, 510180, China. shqwang_cn@163.com.
⁹ Institute of Blood Transfusion and Hematology, Guangzhou Medical University, Guangzhou, China. shqwang_cn@163.com.
¹⁰ Department of Blood Transfusion, School of Medicine, The Second Affiliated Hospital, South China University of Technology, Guangzhou, 510180, China. eywym@scut.edu.cn.
¹¹ Department of Blood Transfusion, Guangzhou First Peoples Hospital, Guangzhou, 510180, China. eywym@scut.edu.cn.
¹² Guangdong Engineering Research Centre of Precise Transfusion, Guangzhou, 510180, China. eywym@scut.edu.cn.
¹³ Institute of Blood Transfusion and Hematology, Guangzhou Medical University, Guangzhou, China. eywym@scut.edu.cn.
¹⁴ Department of Blood Transfusion, School of Medicine, The Second Affiliated Hospital, South China University of Technology, Guangzhou, 510180, China. eyyuanzhaohu@scut.edu.cn.
¹⁵ Department of Blood Transfusion, Guangzhou First Peoples Hospital, Guangzhou, 510180, China. eyyuanzhaohu@scut.edu.cn.
¹⁶ Guangdong Engineering Research Centre of Precise Transfusion, Guangzhou, 510180, China. eyyuanzhaohu@scut.edu.cn.
¹⁷ Institute of Blood Transfusion and Hematology, Guangzhou Medical University, Guangzhou, China. eyyuanzhaohu@scut.edu.cn.

PMID: 40102306
PMCID: PMC12031907
DOI: 10.1007/s00277-025-06213-4

Abstract

To investigate the impact of the ABO blood group major match type on stem cell engraftment, blood transfusion and clinical outcomes in aplastic anemia patients with hematopoietic stem cell transplantation (HSCT), we retrospectively analyzed the data of 361 aplastic anemia patients treated with HSCT, and found ABO major mismatched resulted in delayed red blood cells (RBCs) engraftment and ABO blood group conversion. The patients in the ABO major mismatched group required more units of RBCs and PLTs transfusions. Multivariate linear regression analysis showed that ABO mismatched, acute graft-versus-host disease (aGVHD), time to RBCs and PLTs engraftment and blood group conversion, and baseline hemoglobin were significantly associated with RBCs transfusion, the factors associated with PLTs transfusion were the PLTs, RBCs and neutrophils engraftment, graft rejection, baseline PLTs, aGVHD grade II-IV, and severe chronic GVHD. Multivariate analysis showed that the time to neutrophils engraftment, baseline hemoglobin, and aGVHD were independent poor prognostic factors to both overall survival and failure-free survival. Moreover, the major ABO-mismatched HSCT group were hospitalized more often. These findings suggest that it's better to select a donor with an ABO major match to reduce the burden of transfusion and the impact of hospitalization, if conditions permit.

Keywords: ABO blood group; Aplastic anemia; Hematopoietic stem cell transplantation; Major mismatched transplantation; Survival analysis; Transfusion.

PubMed Disclaimer

Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

**Fig. 1**
The inclusion and exclusion process

**Fig. 2**
Graft engraftment and ABO blood group conversion after HSCT in the ABO major matched group and ABO major mismatched group. a Time to RBCs engraftment; b Time to ABO blood group conversion; c Time to neutrophils engraftment; d Time to PLTs engraftment

**Fig. 3**
RBCs and PLTs transfusions 6 months after HSCT in the ABO major matched group and ABO major mismatched group. a Daily rate of RBCs transfusion after HSCT; b Daily rate of PLTs transfusion after HSCT; c Cumulative rate of RBCs transfusion after HSCT; d Cumulative rate of PLTs transfusion after HSCT

**Fig. 4**
Survival analysis of patients with AA after HSCT and the hospitalization of survival. a Overall survival rate 1 year after HSCT; b Overall survival rate after HSCT; c Failure-free survival rate 1 year after HSCT; d Failure-free survival rate after HSCT; e Length of stay in hospital after HSCT 1 year; f Numbers of hospitalizations after HSCT 1 year; g Length of stay in hospital after HSCT; h Numbers of hospitalizations after HSCT

See this image and copyright information in PMC

References

1. Young NS (2018) Aplastic Anemia. N Engl J Med 379(17):1643–1656. 10.1056/NEJMra1413485 - PMC - PubMed
1. Bacigalupo A (2017) How I treat acquired aplastic anemia. Blood 129(11):1428–1436. 10.1182/blood-2016-08-693481 - PubMed
1. Lv M, Chang Y, Huang X (2019) Everyone has a donor: contribution of the Chinese experience to global practice of haploidentical hematopoietic stem cell transplantation. Frontiers of medicine 13(1):45–56. 10.1007/s11684-017-0595-7 - PubMed
1. Xu LP, Jin S, Wang SQ, Xia LH, Bai H, Gao SJ, Liu QF, Wang JM, Wang X, Jiang M, Zhang X, Wu DP, Huang XJ (2017) Upfront haploidentical transplant for acquired severe aplastic anemia: registry-based comparison with matched related transplant. J Hematol Oncol 10(1):25 - PMC - PubMed
1. Zhang Y, Huo J, Liu L, Shen Y, Chen J, Zhang T, Chen X, Pang A, Yang D, Zhang R, Ma Q, Zhai W, He Y, Wei J, Jiang E, Han M, Zheng Y, Feng S (2022) Comparison of Hematopoietic Stem Cell Transplantation Outcomes Using Matched Sibling Donors, Haploidentical Donors, and Immunosuppressive Therapy for Patients With Acquired Aplastic Anemia. Front Immunol 13:837335 - PMC - PubMed

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Substances

Actions

LinkOut - more resources

Full Text Sources
- PubMed Central
- Springer
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Effect of major ABO blood group mismatched HSCT on blood transfusion and clinical outcomes in AA patients

Affiliations

Effect of major ABO blood group mismatched HSCT on blood transfusion and clinical outcomes in AA patients

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Similar articles

References

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical

Abstract

Conflict of interest statement

Figures

Similar articles

References

MeSH terms

Substances

Related information

LinkOut - more resources

Full Text Sources

Medical