Prophylactic red blood cell exchange for ABO-mismatched hematopoietic progenitor cell transplants

Authors

  • Robyn Cunard,

    Corresponding author
    1. Research Service and Division of Nephrology-Hypertension, Veterans Affairs San Diego Healthcare System, Veterans Medical Research Foundation, San Diego, California
    2. Department of Medicine, Pathology and Moore's Cancer Center, University of California at San Diego, La Jolla, California
    • Address reprint requests to: Robyn Cunard, MD, Research and Medicine Services, Division of Nephrology, Veterans Affairs San Diego Healthcare System, Mail Code 151, 3350 La Jolla Village Drive, San Diego, CA 92161; e-mail: rcunard@ucsd.edu.

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  • Isagani I. Marquez,

    1. Department of Medicine, Pathology and Moore's Cancer Center, University of California at San Diego, La Jolla, California
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  • Edward D. Ball,

    1. Department of Medicine, Pathology and Moore's Cancer Center, University of California at San Diego, La Jolla, California
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  • Connie L. Nelson,

    1. Department of Medicine, Pathology and Moore's Cancer Center, University of California at San Diego, La Jolla, California
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  • Sue Corringham,

    1. Department of Medicine, Pathology and Moore's Cancer Center, University of California at San Diego, La Jolla, California
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  • Paul Clopton,

    1. Research Service and Division of Nephrology-Hypertension, Veterans Affairs San Diego Healthcare System, Veterans Medical Research Foundation, San Diego, California
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  • Amber P. Sanchez,

    1. Department of Medicine, Pathology and Moore's Cancer Center, University of California at San Diego, La Jolla, California
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  • Thomas Lane,

    1. Department of Medicine, Pathology and Moore's Cancer Center, University of California at San Diego, La Jolla, California
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  • David M. Ward

    1. Department of Medicine, Pathology and Moore's Cancer Center, University of California at San Diego, La Jolla, California
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Abstract

Background

To enhance donor availability, almost half of hematopoietic progenitor cell transplants (HPCTs) cross ABO blood type boundaries. ABO-incompatible HPCTs are well tolerated; however, there is an increased risk of delayed hemolysis in patients with minor and bidirectional ABO mismatches. Delayed hemolysis generally occurs 1 to 2 weeks after HPCT and is related to production of alloantibodies directed against recipient ABO red blood cell (RBC) antigens by passenger donor lymphocytes. One previous study has suggested that prophylactic RBC exchange in patients with minor and bidirectional ABO-mismatched HPCT reduces the risks of severe immune hemolysis, but this recommendation is controversial.

Study Design and Methods

Herein we describe our experience using prophylactic RBC exchange in patients with minor and bidirectional ABO-mismatched HPCTs who were deemed to be at high risk for immune hemolysis. We compare the group of patients that received prophylactic RBC exchange with a historical cohort of ABO-mismatched patients who underwent HPCT without prophylactic RBC exchange.

Results

Our study suggests that prophylactic RBC exchange in minor and bidirectional ABO-mismatched HPCT does not reduce severe immune hemolysis, nor does it improve 1-year survival, the number of RBC units transfused after transplant, or length of hospitalization after HPCT.

Conclusion

This study failed to identify a clear role for selected prophylactic RBC exchange in patients who were deemed at risk for severe post-HPCT immune hemolysis.

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