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Pre-transplant donor-type red cell transfusion is a safe and effective strategy to reduce isohemagglutinin titers and prevent donor marrow infusion reactions in major ABO-mismatched transplants

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Abstract

ABO incompatibility is not a barrier to allogeneic stem cell transplant but may result in acute hemolytic reactions. As stem cell product manipulation is cumbersome, we are reporting the effectiveness and safety of donor-type red cell infusion as a method of reducing acute hemolytic reaction while using marrow as stem cell source. In major ABO-mismatched bone marrow transplants, manipulation of marrow product requires expertise and expensive equipment, which may not be readily available to transplant centers in low- and middle-income regions. The aim behind our study is to report a safe and effective strategy to reduce isohemagglutinin titers and prevent donor marrow infusion reactions in major ABO-mismatched transplants. We retrospectively analyzed 303 consecutive allogeneic bone marrow transplants (BMTs) for beta thalassemia major, between August 2015 and March 2020, with either major (n = 41) or bidirectional (n = 14) mismatches. When isohemagglutinin titers were 1:32 or higher, donor-type packed red blood cell was divided into 4 aliquots, irradiated and administered over 4 days at incremental volumes. Patients were observed for hemolytic reaction, and if no reaction, bone marrow was infused without manipulation. Out of 55 patients, 20 received donor-type blood infusion. Twelve patients showed evidence of mild hemolysis. None developed severe hemolytic or anaphylactic reaction. Titers were rechecked in 14 patients and all had reduction in titers, except for one. Our experience demonstrated that donor-type PRBC infusion is safe and effective in preventing acute hemolysis in major ABO-mismatched stem cell transplants even with bone marrow as graft source.

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Acknowledgments

We would like to thank all the staff and members of Sankalp-People Tree Paediatric Bone Marrow Transplant Unit, People Tree Hospital, Bangalore, India; Sankalp India Foundation, Bangalore, India; Care Institute of Medical Sciences, Sankalp-CIMS Centre for Pediatric BMT, Ahmedabad, India; and Cure2Children Foundation, Florence, Italy, for their contribution towards this study.

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Authors and Affiliations

  1. Sankalp-People tree Paediatric Bone Marrow Transplant Unit, People Tree Hospital, Bangalore, India

    Pallavi Mehta, Stalin Ramprakash & C P Raghuram

  2. Hemato-Oncology and Stem Cell Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi, 110085, India

    Pallavi Mehta

  3. Care Institute of Medical Sciences, Sankalp-CIMS Centre for Pediatric BMT, Ahmedabad, India

    Deepa Trivedi

  4. Sankalp India Foundation, Bangalore, India

    Rakesh Dhanya & Rajat Kumar Agarwal

  5. Cure2Children Foundation, Florence, Italy

    Lawrence Faulkner

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  1. Pallavi Mehta
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  2. Stalin Ramprakash
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Correspondence to Pallavi Mehta.

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All authors stated that the study have been approved by the appropriate institutional review board and have been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Since this is a retrospective study, hence, no formal informed consent is required.

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Since this study was a retrospective medical record–based study, no formal consent was taken from patient for participation. Confidentiality of the patients is maintained.

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Mehta, P., Ramprakash, S., Raghuram, C.P. et al. Pre-transplant donor-type red cell transfusion is a safe and effective strategy to reduce isohemagglutinin titers and prevent donor marrow infusion reactions in major ABO-mismatched transplants. Ann Hematol 100, 2071–2078 (2021). https://doi.org/10.1007/s00277-021-04571-3

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