Published online 2 October 2008
Haematologica, Vol 93, Issue 11, 1686-1693 doi:10.3324/haematol.12933
Copyright © 2008 by Ferrata Storti Foundation

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Original Articles

Impact of AB0-blood group incompatibility on the outcome of recipients of bone marrow transplants from unrelated donors in the Japan Marrow Donor Program

Fumihiko Kimura¹, Ken Sato¹, Shinichi Kobayashi¹, Takashi Ikeda^1,2, Hiroshi Sao³, Shinichiro Okamoto⁴, Koichi Miyamura⁵, Shinichiro Mori⁶, Hideki Akiyama⁷, Makoto Hirokawa⁸, Hitoshi Ohto⁹, Hiroshi Ashida¹⁰, Kazuo Motoyoshi¹ for The Japan Marrow Donor Program

¹ Division of Hematology, National Defense Medical College, Tokorozawa
² Stem Cell Transplantation, Shizuoka Cancer Center Hospital, Shizuoka
³ Department of Hematology, Meitetsu Hospital, Nagoya
⁴ Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo
⁵ Division of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya
⁶ Hematopoietic Stem Cell Transplantation Unit, National Cancer Center Hospital, Tokyo
⁷ Hematology Division, Tokyo Metropolitan Komagome Hospital, Tokyo
⁸ Medical Committee, Japan Marrow Donor Program, Tokyo
⁹ Donor Safety Committee, Japan Marrow Donor Program, Tokyo and
¹⁰ Division of Biomedical Information Sciences, National Defense Medical College Research Institute, Tokorozawa, Japan

Correspondence: Kazuo Motoyoshi, 3-2, Namiki, Tokorozawa, Saitama 359-8513, Japan. E-mail:motoyosi{at}ndmc.ac.jp

Background: Although the AB0 blood group is one of two major antigen systems of relevance for transplantation in humans, there are still conflicting data concerning the influence of AB0 incompatibility on transplant outcome. This study investigated the effect of AB0 incompatibility in recipients of bone marrow transplants from unrelated donors.

Design and Methods: We retrospectively analyzed data from 5,549 patients who underwent bone marrow transplantation from unrelated donors in the Japan Marrow Donor Program.

Results: Overall survival rates in the group with major and minor mismatches were significantly lower than the rate in the AB0-identical group (AB0-identical 63.0%; major mismatch, 56.9%; minor mismatch, 57.1% at 1 year). Treatment-related mortality was higher in the major and minor mismatch groups, but there was no significant difference in the rate of relapse. Cox proportional hazards modeling showed that both major and minor AB0 incompatibility were significant risk factors for transplant-related mortality, independently of disease, patients’ age, and HLA incompatibility. Delayed engraftment of neutrophils, platelets, and erythrocytes was observed in transplants with major incompatibility. There was a high incidence of grade 3 and 4 acute graft-versus-host disease in the groups with major and minor mismatches, which was caused by a high incidence of stage 2 to 4 liver graft-versus-host disease. Interestingly, the risk of grade 2 to 4 graft-versus-host disease in the major mismatch group was higher in patients with early engraftment of erythrocytes. Among the patients receiving reduced-intensity conditioning, the transplant-related mortality was also increased in AB0-incompatible transplants.

Conclusions: Major and minor AB0 incompatibility have specific effects on transplant-related mortality and acute graft-versus-host disease in recipients of bone marrow transplants from unrelated donors.

Key words: bone marrow transplantation, unrelated donor, AB0 blood type, acute graft-vs-host disease, graft failure.

Related Article

AB0-incompatible allogeneic hematopoietic stem cell transplantation

Nina Worel, Peter Kalhs
Haematologica 2008 93: 1605-1607. [Full Text] [PDF]

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