ABO血型不合异基因外周血干细胞移植对红系造血重建的影响

THE AFFECT OF THE ABO BLOOD GROUP ON THE HEMATOPOIETIC RECONSITITUTION IN ALLO-PBSCT FOR MALIGNANCE HEMATOLOGICAL DISEASE

为研究ABO血型不合对Allo PBSCT患者造血重建的影响 ,将 2 0例恶性血液病(CML 9例、ALL 8例、难治性NHL 3例 )按统计学配对原则分组 ,ABO血型异同者各 10例 ,两组年龄、性别、诊断、移植前病程、疾病状态、预处理方案、输注的MNC和CD34+ 细胞量及GVHD预防方法均无明显差异(P >0 0 5 )。外周血干细胞经G CSF动员后CS 30 0 0Plus分离 ,移植后定期检查血象和血型抗体滴度。结果显示 ,血型转为供者型的中位数时间 (40 2± 2 5 )天 ,白细胞、血小板达正常水平在两组中无明显差异 (P >0 0 5 ) ,而血红蛋白 <110g/L者在ABO血型不合组明显高于ABO血型相合组 (5 5 %∶2 5 % ,P <0 0 1)。 6例ABO血型主要不合者 3例发生纯红再障。提示供受者ABO血型不合影响红系造血重建 ,主要血型抗原不合时容易发生纯红再障 。

To Study the effects of the ABO blood group incompatibility on hematopoietic reconstitution in Allo PBSCT for malignant hematological diseases. There were 9 patients with CML, 8 patients with ALL, and 3 patients with refractory NHL among the 20 cases of patients. Their median course of disease was 8 5 months before PBSCT. Among them, 10 cases were ABO incompatible and 10 cases ABO compatible by ABO blood grouping between donor and recipients. The age, sex, diagnosis, course of disease, disease status before transplantation, conditioning regimen, number of infused MNC and CD34 + cells, GVHD preventing regimen in both groups were not significantly different ( P >0 05). The PBSC with red blood cells(8～11ml) without elimination before infusion were harvested by CS 3000 Plus.The leve1 of blood group antigens and antibodies and bone marrow cells morphology were examined at different intervals after transplantation. No patient showed acute haemolysis in the ABO incompatible group. The median time of blood type transformation was 40 2±25 days. The median time for recovery of normal WBC and Plt in ABO incompatible groups was 10 days longer than that in the ABO compatible group. The number of patients with Hb<110g/L was significant larger in blood group incompatible group than that in ABO compatible group (55%vs 25%) after 75±35 days. Three of seven patients with major blood group antigen incompatible developed pure red cell aplasia. ABO blood group incompatible between the donor and recipient significantly affected erythropoiesis reconsititution in Allo PBSCT in patients with malignant hematologic diseases. There was no significant difference in incidence of GVHD and transplantation related in two groups.