АВ0-INCOMPATIBILITY IN ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION: 15-YEARS EXPERIENCE OF R.M. GORBACHEVA MEMORIAL RESEARCH INSTITUTE FOR CHILDREN ONCOLOGY, HEMATOLOGY AND TRANSPLANTATION

Abstract

Introduction. There is an increased incidence of AB0 incompatibility-50-60%, in allogeneic hematopoietic stem cell transplantation (alloHSCT) in patients who are Russian citizens as a result of the variability of genetic polymorphism in the multi-ethnic population and a significant number of unrelated donors from international bone marrow registries. AB0 incompatibility in different types of alloHSCT may be an additional aggravating factor for the development of immunological complications and decrease effectiveness of treatment, but the data is still controversial [1]. Patients and methods. From May 1999 to December 2015 in Raisa Gorbacheva Memorial Institute for Children Oncology, Hematology and Transplantation 1131 patients with leukemia, malignancies and hereditary diseases were included to the study, who were performed 1428 HSCT: allogeneic unrelated-814 (57%) allogeneic related-344 (24,1%) haploidentical-267 (18,7%) umbilical cord blood in 3 patients (0,2%). Age was 0-76, median-25 years. Patients were predominantly with acute myeloid leukemia-37% (n=602), acute lymphoblastic leukemia-30% (n=501) and chronic myeloid leukemia-6% (n=94). Results. In 54,6% of cases (n=780) AB0 incompatibility was determined: major-37,8% (n=295) minor-45,4% (n=354) combined-16,8% (n=131). AB0 incompatibility in alloHSCT did not influence overall survival (p=0,56) and frequency of acute graft versus host disease (GvHD) (p=0,2). Also there was no difference in overall survival depending on combination of condition regimen and AB0 incompatibility: reduced intensity (RIC) or myeloablative (MAC) (p=0,7). An increased frequency of acute GvHD was observed in RIC and AB0 incompatibility (30,8%) compared to MAC (15,3%, p=0,002). AB0 incompatibility was not a major factor (log worth 0,87) which influenced the fact and speed of donor's transplant engraftment in comparison to level of HLA-compatibility (11,5), hematopoietic stem cell source (7,05) and type of HSCT. But the presence of major AB0 incompatibility increase the period of erythroid recovery (p=0,01) as reflected in the higher amount of blood transfusions. Complications caused by AB0 incompatibility were identified in 2,4% of all cases (n=34) including acute and delayed hemolysis, partial red cell aplasia and immune thrombocytopenia. Conclusion. The presence of AB0 incompatibility is not a limiting factor to perform alloHSCT, however, it demands high quality prophylaxis and accurate transfusion therapy depending on AB0 incompatibility type to prevent immune complications.