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. 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

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.

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.

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Conflict of interest statement

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

Figures

Fig. 1
Fig. 1
The inclusion and exclusion process
Fig. 2
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
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
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

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