Suppression of passenger lymphococyte mediated hemolysis in abo minor mismatched allogeneic peripheral blood hematopoietic cell transplantation

Issara Makhoul, Joseph Mierski, Michael Bongiovani, W. Christopher Ehmann, Witold Rybka

Research output: Contribution to journalArticle

Abstract

Donor(D)/recipient(R) minor blood group mismatch can be responsible for severe and sometimes life threatening immune hemolysis following allogeneic bone marrow transplantation (BMT). This phenomenon has been attributed to mediation by passenger lymphocytes. We reviewed 41 consecutive non-purged peripheral blood hematopoietic cell transplant(PBHCT) patients for early hemolysis. Data for hematocrit, bilirubin, and LDH (drop>5%, increase>2X baseline, 2XNL, respectively) were used to screen for hemolysis. Suspected cases were reviewed for direct antiglobulin reaction (DAT), antibodies(Abs) to recipient group, the time to conversion to donor blood type, and for the quantity and type of PRBC transfused. Immune hemolysis was identified in 0/25 ABO matched. 0/5 major ABO mismatched and 4/11 minor ABO mismatched recipients(p =0.002). The first 13 patients received tacrolimus alone for graft-versus-host disease prophylaxis(GpI), while the subsequent 28 patients received tacrolimus and short course methotrexate, 5 mg An2 days 1,3,6,11 (GpII). For minor ABO mismatched recipients, 3/3 in Gpl compared to 1/8 in GpII experienced immune hemolysis (p=0.02 ). Immune hemolysis started between D5 and D8, earlier than previously reported with BMT. and before any evidence of engraftment. All patients developed Abs to the recipient blood type. However, only one patient (#4) had a positive DAT. 3 patients received washed O and one donor-type PRBC, excluding the possibility of passive transfer of Abs. The hemolysis was severe requiring the transfusion of an average of 11.8 (range 6-15)PRBC units compared to 7.3 (range 0-21)units in the other 37 patients. In conclusion , the frequency of immune hemolysis related to minor ABO mismatch following PBHCT (36%) is higher than historical experience with BMT(15%)(p=0.07 ). It produces early severe hemolysis prior to engraftment. The finding that cytotoxic therapy with methotrexate appears to ablate this reaction supports the hypothesis of a cell mediated mechanism. Pt# ABO duration of days to ABO Abs to recipient DAT PRBCs D/R hemolysis conversion type transfused 1 O /B 5-10 39 weakly+ D8, 1:32 D14, neg 10 units, O 1:4 D21 2 OVA 8-11 11 4+D8-11 neg 6 units.O 3 OVA 5-15 7 2+D7,4+D8-20 neg ISunits, O 4 OVA 6-12 11 Anti-Al by elution, D6 pos 12 units, 4A and 9 O.

Original languageEnglish (US)
JournalBlood
Volume96
Issue number11 PART II
StatePublished - Dec 1 2000

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Cell Transplantation
Hemolysis
Blood Cells
Blood
Anti-Idiotypic Antibodies
Transplants
Bone
Antibodies
Tacrolimus
Methotrexate
Bone Marrow Transplantation
Lymphocytes
Blood Group Antigens
Bilirubin
Grafts
Tissue Donors
Passive Immunization
Homologous Transplantation
Graft vs Host Disease
Blood Donors

All Science Journal Classification (ASJC) codes

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

Cite this

@article{ed734f85da9245e8894ab259b0a82a2e,
title = "Suppression of passenger lymphococyte mediated hemolysis in abo minor mismatched allogeneic peripheral blood hematopoietic cell transplantation",
abstract = "Donor(D)/recipient(R) minor blood group mismatch can be responsible for severe and sometimes life threatening immune hemolysis following allogeneic bone marrow transplantation (BMT). This phenomenon has been attributed to mediation by passenger lymphocytes. We reviewed 41 consecutive non-purged peripheral blood hematopoietic cell transplant(PBHCT) patients for early hemolysis. Data for hematocrit, bilirubin, and LDH (drop>5{\%}, increase>2X baseline, 2XNL, respectively) were used to screen for hemolysis. Suspected cases were reviewed for direct antiglobulin reaction (DAT), antibodies(Abs) to recipient group, the time to conversion to donor blood type, and for the quantity and type of PRBC transfused. Immune hemolysis was identified in 0/25 ABO matched. 0/5 major ABO mismatched and 4/11 minor ABO mismatched recipients(p =0.002). The first 13 patients received tacrolimus alone for graft-versus-host disease prophylaxis(GpI), while the subsequent 28 patients received tacrolimus and short course methotrexate, 5 mg An2 days 1,3,6,11 (GpII). For minor ABO mismatched recipients, 3/3 in Gpl compared to 1/8 in GpII experienced immune hemolysis (p=0.02 ). Immune hemolysis started between D5 and D8, earlier than previously reported with BMT. and before any evidence of engraftment. All patients developed Abs to the recipient blood type. However, only one patient (#4) had a positive DAT. 3 patients received washed O and one donor-type PRBC, excluding the possibility of passive transfer of Abs. The hemolysis was severe requiring the transfusion of an average of 11.8 (range 6-15)PRBC units compared to 7.3 (range 0-21)units in the other 37 patients. In conclusion , the frequency of immune hemolysis related to minor ABO mismatch following PBHCT (36{\%}) is higher than historical experience with BMT(15{\%})(p=0.07 ). It produces early severe hemolysis prior to engraftment. The finding that cytotoxic therapy with methotrexate appears to ablate this reaction supports the hypothesis of a cell mediated mechanism. Pt# ABO duration of days to ABO Abs to recipient DAT PRBCs D/R hemolysis conversion type transfused 1 O /B 5-10 39 weakly+ D8, 1:32 D14, neg 10 units, O 1:4 D21 2 OVA 8-11 11 4+D8-11 neg 6 units.O 3 OVA 5-15 7 2+D7,4+D8-20 neg ISunits, O 4 OVA 6-12 11 Anti-Al by elution, D6 pos 12 units, 4A and 9 O.",
author = "Issara Makhoul and Joseph Mierski and Michael Bongiovani and Ehmann, {W. Christopher} and Witold Rybka",
year = "2000",
month = "12",
day = "1",
language = "English (US)",
volume = "96",
journal = "Blood",
issn = "0006-4971",
publisher = "American Society of Hematology",
number = "11 PART II",

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Suppression of passenger lymphococyte mediated hemolysis in abo minor mismatched allogeneic peripheral blood hematopoietic cell transplantation. / Makhoul, Issara; Mierski, Joseph; Bongiovani, Michael; Ehmann, W. Christopher; Rybka, Witold.

In: Blood, Vol. 96, No. 11 PART II, 01.12.2000.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Suppression of passenger lymphococyte mediated hemolysis in abo minor mismatched allogeneic peripheral blood hematopoietic cell transplantation

AU - Makhoul, Issara

AU - Mierski, Joseph

AU - Bongiovani, Michael

AU - Ehmann, W. Christopher

AU - Rybka, Witold

PY - 2000/12/1

Y1 - 2000/12/1

N2 - Donor(D)/recipient(R) minor blood group mismatch can be responsible for severe and sometimes life threatening immune hemolysis following allogeneic bone marrow transplantation (BMT). This phenomenon has been attributed to mediation by passenger lymphocytes. We reviewed 41 consecutive non-purged peripheral blood hematopoietic cell transplant(PBHCT) patients for early hemolysis. Data for hematocrit, bilirubin, and LDH (drop>5%, increase>2X baseline, 2XNL, respectively) were used to screen for hemolysis. Suspected cases were reviewed for direct antiglobulin reaction (DAT), antibodies(Abs) to recipient group, the time to conversion to donor blood type, and for the quantity and type of PRBC transfused. Immune hemolysis was identified in 0/25 ABO matched. 0/5 major ABO mismatched and 4/11 minor ABO mismatched recipients(p =0.002). The first 13 patients received tacrolimus alone for graft-versus-host disease prophylaxis(GpI), while the subsequent 28 patients received tacrolimus and short course methotrexate, 5 mg An2 days 1,3,6,11 (GpII). For minor ABO mismatched recipients, 3/3 in Gpl compared to 1/8 in GpII experienced immune hemolysis (p=0.02 ). Immune hemolysis started between D5 and D8, earlier than previously reported with BMT. and before any evidence of engraftment. All patients developed Abs to the recipient blood type. However, only one patient (#4) had a positive DAT. 3 patients received washed O and one donor-type PRBC, excluding the possibility of passive transfer of Abs. The hemolysis was severe requiring the transfusion of an average of 11.8 (range 6-15)PRBC units compared to 7.3 (range 0-21)units in the other 37 patients. In conclusion , the frequency of immune hemolysis related to minor ABO mismatch following PBHCT (36%) is higher than historical experience with BMT(15%)(p=0.07 ). It produces early severe hemolysis prior to engraftment. The finding that cytotoxic therapy with methotrexate appears to ablate this reaction supports the hypothesis of a cell mediated mechanism. Pt# ABO duration of days to ABO Abs to recipient DAT PRBCs D/R hemolysis conversion type transfused 1 O /B 5-10 39 weakly+ D8, 1:32 D14, neg 10 units, O 1:4 D21 2 OVA 8-11 11 4+D8-11 neg 6 units.O 3 OVA 5-15 7 2+D7,4+D8-20 neg ISunits, O 4 OVA 6-12 11 Anti-Al by elution, D6 pos 12 units, 4A and 9 O.

AB - Donor(D)/recipient(R) minor blood group mismatch can be responsible for severe and sometimes life threatening immune hemolysis following allogeneic bone marrow transplantation (BMT). This phenomenon has been attributed to mediation by passenger lymphocytes. We reviewed 41 consecutive non-purged peripheral blood hematopoietic cell transplant(PBHCT) patients for early hemolysis. Data for hematocrit, bilirubin, and LDH (drop>5%, increase>2X baseline, 2XNL, respectively) were used to screen for hemolysis. Suspected cases were reviewed for direct antiglobulin reaction (DAT), antibodies(Abs) to recipient group, the time to conversion to donor blood type, and for the quantity and type of PRBC transfused. Immune hemolysis was identified in 0/25 ABO matched. 0/5 major ABO mismatched and 4/11 minor ABO mismatched recipients(p =0.002). The first 13 patients received tacrolimus alone for graft-versus-host disease prophylaxis(GpI), while the subsequent 28 patients received tacrolimus and short course methotrexate, 5 mg An2 days 1,3,6,11 (GpII). For minor ABO mismatched recipients, 3/3 in Gpl compared to 1/8 in GpII experienced immune hemolysis (p=0.02 ). Immune hemolysis started between D5 and D8, earlier than previously reported with BMT. and before any evidence of engraftment. All patients developed Abs to the recipient blood type. However, only one patient (#4) had a positive DAT. 3 patients received washed O and one donor-type PRBC, excluding the possibility of passive transfer of Abs. The hemolysis was severe requiring the transfusion of an average of 11.8 (range 6-15)PRBC units compared to 7.3 (range 0-21)units in the other 37 patients. In conclusion , the frequency of immune hemolysis related to minor ABO mismatch following PBHCT (36%) is higher than historical experience with BMT(15%)(p=0.07 ). It produces early severe hemolysis prior to engraftment. The finding that cytotoxic therapy with methotrexate appears to ablate this reaction supports the hypothesis of a cell mediated mechanism. Pt# ABO duration of days to ABO Abs to recipient DAT PRBCs D/R hemolysis conversion type transfused 1 O /B 5-10 39 weakly+ D8, 1:32 D14, neg 10 units, O 1:4 D21 2 OVA 8-11 11 4+D8-11 neg 6 units.O 3 OVA 5-15 7 2+D7,4+D8-20 neg ISunits, O 4 OVA 6-12 11 Anti-Al by elution, D6 pos 12 units, 4A and 9 O.

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