Korean J Hematol.  2005 Dec;40(4):254-260. 10.5045/kjh.2005.40.4.254.

The Feasibility and Clinical Efficacy of In Vivo Adsorption of Isohemagglutinins with Fresh Frozen Plasma (FFP) Infusion in Major ABO-incompatible Allogeneic Stem Cell Transplantation

• Lee SR
• Yang DH
• Lee JJ
• Kim YK
• Cho SH
• Chung IJ
• Kim HJ

• KMID: 2083463
• DOI: http://doi.org/10.5045/kjh.2005.40.4.254

Abstract

BACKGROUND
We evaluated the efficacy and feasibility of performing prolonged donor type fresh frozen plasma (FFP) infusion for the in vivo adsorption of isohemagglutinins (IHGs) in major ABO-incompatible allogeneic stem cell transplantation.
METHODS
Forty-five patients underwent allogeneic stem cell transplantation. Major ABO incompatibility was observed in 23 patients. 18 patients of these 23 patients had IHGs directed towards the donor ABO antigens and they received donor type FFP; in 5 patients, the bone marrow grafts were minor incompatible; in 17 patients, the grafts were compatible.
RESULTS
The engraftment times of the granulocytes and platelets and the transfusion requirements for red blood cells in the FFP-transfused recipients of the major ABO-incompatible allografts were not different from those of therecipients of ABO-compatible allografts (P>0.1) and these factors were not different from those for the FFP-treated recipients of the major ABO-incompatible allografts. The median duration of FFP infusion and the number of FFP units were 23.5 days (range 8~39) and 47 units (range 16~78), respectively. The median IgG titers decreased from 1:64 to 1:4 over a median of 22.5 days (range 8~36) in the FFP-treated groups, compared with a median of 61 days (range 19~116) in the non-FFP-treated groups.
CONCLUSION
The infusion of donor-type FFP with red cell depletion represents a more feasible, effective alternative strategy to achieve in vivo immunoadsorption of IHGs and to prevent late immunohematologic complications.

Keyword

Fresh frozen plasma; Isohemagglutinins; Major ABO incompatible bone marrow transplantation

MeSH Terms

Adsorption*
Allografts
Bone Marrow
Erythrocytes
Granulocytes
Hemagglutinins*
Humans
Immunoglobulin G
Plasma*
Stem Cell Transplantation*
Stem Cells*
Tissue Donors
Transplants
Hemagglutinins
Immunoglobulin G

Reference

1). Gale RP, Feig S, Ho W, Falk P, Rippee C, Sparkes R. ABO blood group system and bone marrow transplantation. Blood. 1977; 50:185–94.

2). Buckner CD, Clift RA, Sanders JE, et al. ABO-incompatible marrow transplants. Transplantation. 1978; 26:233–8.

3). Berkman EM, Caplan S, Kim CS. ABO-incompatible bone marrow transplantation: preparation by plasma exchange and in vivo antibody absorption. Transfusion. 1978; 18:504–8.

4). Bensinger WI, Baker DA, Buckner CD, Clift RA, Thomas ED. Immunoadsorption for removal of A and B blood-group antibodies. N Engl J Med. 1981; 304:160–2.

5). Bensinger WI, Buckner CD, Thomas ED, Clift RA. ABO-incompatible marrow transplants. Transplantation. 1982; 33:427–9.

6). Osterwalder B, Gratwohl A, Nissen C, Speck B. Immunoadsorption for removal of anti-A and anti-B blood group antibodies in ABO-incompatible bone marrow transplantation. Blut. 1986; 53:379–90.

7). Nussbaumer W, Schwaighofer H, Gratwohl A, et al. Transfusion of donor-type red cells as a single preparative treatment for bone marrow transplants with major-ABO incompatibility. Transfusion. 1995; 35:592–5.

8). Webb IJ, Soiffer RJ, Andersen JW, et al. In vivo adsorption of isohemagglutinins with fresh frozen plasma in major ABO-incompatible bone marrow transplantation. Biol Blood Marrow Transplant. 1997; 3:267–72.

9). Blacklock HA, Gilmore MJ, Prentice HG, et al. ABO incompatible bone‐marrow transplantation: removal of red blood cells from donor marrow avoiding recipient antibody depletion. Lancet. 1982; 2:1061–4.

10). Sniecinski I, Henry S, Ritchey B, Branch DR, Blume KG. Erythrocyte depletion of ABO-incompatible bone marrow. J Clin Apher. 1985; 2:231–4.

11). Jin NR, Hill R, Segal G, et al. Preparation of red-blood-cell-depleted marrow for ABO-incompatible marrow transplantation by density-gradient separation using the IBM 2991 blood cell processor. Exp Hematol. 1987; 15:93–8.

12). Sniecinski IJ, Oien L, Petz LD, Blume KG. Immunohematologic consequences of major ABO mismatched bone marrow transplantation. Transplantation. 1988; 45:530–4.

13). Schanz U, Gmur J. Rapid and automated processing of bone marrow grafts without Ficoll density gradient for transplantation of cryopreserved autologous or ABO-incompatible allogeneic bone marrow. Bone Marrow Transplant. 1992; 10:507–13.

14). Mayer G, Wernet D, Northoff H, Schneider W. A simple technique for red blood cell removal in major ABO-incompatible bone marrow transplantation. Vox Sang. 1994; 66:112–6.

15). Hows JM, Chipping PM, Palmer S, Gordon-Smith EC. Regeneration of peripheral blood cells following ABO incompatible allogeneic bone marrow transplantation for severe aplastic anaemia. Br J Haematol. 1983; 53:145–51.

16). Wulff JC, Santner TJ, Storb R, et al. Transfusion requirements after HLA-identical marrow transplantation in 82 patients with aplastic anemia. Vox Sang. 1983; 44:366–74.

17). Bensinger W, Petersen FB, Banaji M, et al. Engraftment and transfusion requirements after allogeneic marrow transplantation for patients with acute non lymphocytic leukemia in first complete remission. Bone Marrow Transplant. 1989; 4:409–14.

18). Pihlstedt P, Paulin T, Sundberg B, Nilsson B, Ringden O. Blood transfusion in marrow graft recipients. Ann Hematol. 1992; 65:66–70.

19). Mehta J, Powles R, Singhal S, et al. Transfusion requirements after bone marrow transplantation from HLA-identical siblings: effects of donor‐recipient ABO incompatibility. Bone Marrow Transplant. 1996; 18:151–6.

20). Warkentin PI, Yomtovian R, Hurd D, et al. Severe delayed hemolytic transfusion reaction complicating an ABO-incompatible bone marrow transplantation. Vox Sang. 1983; 45:40–7.

21). Gmur JP, Burger J, Schaffner A, et al. Pure red cell aplasia of long duration complicating major ABO incompatible bone marrow transplantation. Blood. 1990; 75:290–5.

22). Ockelford PA, Hill RS, Nelson L, Blacklock HA, Woodfield DG, Matthews JR. Serological complications of a major ABO incompatible bone marrow transplantation in a Polynesian with aplastic anemia. Transfusion. 1982; 22:62–5.

23). Bensinger WI, Buckner CD, Thomas ED, Clift RA. ABO-incompatible marrow transplants. Transplantation. 1982; 33:427–9.

24). Tilley CA, Crookston MC, Brown BL, Wherrett JR. A and B and A1Leb substances in glycosphingolipid fractions of human serum. Vox Sang. 1975; 28:25–33.

25). Shanwell A, Ringden O, Wiechel B, Rumin S, Akerblom O. A study of the effect of ABO incompatible plasma in platelet concentrates transfused to bone marrow transplant recipients. Vox Sang. 1991; 60:23–7.

26). Stussi G, Muntwyler J, Passweg JR, et al. Consequences of ABO incompatibility in allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant. 2002; 30:87–93.