ABO血型对异基因造血干细胞移植患者植入的影响探讨

Exploring the impact of ABO blood group on the outcomes of allogeneic hematopoietic cell transplantation

目的探讨ABO同型及3种ABO血型不合对异基因造血干细胞移植患者各系植入的影响,为患者优化移植方案提供依据。方法回顾性分析本院2014年1月~2018年6月期间进行异基因造血干细胞移植患者70例,ABO同型18例,ABO血型不合52例,在确保对比组患者年龄;性别;供/受者亲缘关系;疾病诊断;移植前骨髓造血功能状况;HLA相合情况无差异的情况下,对比分析患者粒系、红系、巨核系植入时间,移植后3个月内红细胞及血小板输注量,ABO血型不合的血型开始转化时间、转化完成时间等指标。研究以上指标在ABO同型及3种ABO血型不合移植中有无差异。结果 70例患者中,ABO同型18例,粒系植入时间12.0(11.0~16.3)d,红系植入时间41.5(35.0~49.0)d,巨核系植入时间19.0(16.0~22.5)d。ABO血型不合52例,移植后血型开始转化时间28.0(22.5~44.0)d,转化完成时间105.5(85.0~141.8)d,粒系植入时间14.5(12.0~16.0)d,红系植入时间61.0(39.5~85.0)d,巨核系植入时间23.0(18.0~31.0)d。ABO同型相较ABO血型不合(主要/主次要双向不合)异基因造血干细胞移植红系植入时间缩短(P<0.05),红细胞及血小板输注量减少(P<0.05),粒系、巨核系植入时间无显著性差异(P>0.05)。ABO血型主要不相合、次要不相合、主次要双向不合异基因造血干细胞移植中的血型转化时间,粒系、红系、巨核系植入时间,红细胞、血小板输注量均无差异(P>0.05)。结论异基因造血干细胞移植优先选择ABO同型供者,在缺乏同型供者情况下,优先选择次要不相合,其次主要不相合、主次要双向不合供者。

Objective To investigate the impact of ABO blood group compatibility and incompatibility(major/minor/bidirectional incompatibility) on the outcomes of patients underwent allogeneic hematopoietic stem cell transplantation(allo-HSCT), and to provide evidences for optimizing the transplantation program. Methods From January 2014 to June 2018, we retrospectively reviewed the clinical courses of 18 recipients of allo-HSCT from ABO-compatible donors and 52 from ABO-incompatible donors at our hospital. The implantation time of granulocyte/erythrocyte/megakaryoblast, RBC/platelet transfusions within 3 months posttransplantation, the initiating and completion time of ABO blood group conversion(for ABO-compatible donors only) were analyzed and compared among the ABO-incompatible and ABO-compatible donors as such variables including demographic data, donor and patient relationship, diagnosis of disease, bone marrow hematopoietic function prior to transplantation, HLA matching were not significant different.Results For 18 recipients of allo-HSCT from ABO-compatible donors, the implantation time of granulocyte, erythrocyte, megakaryoblast was 12.0(11.0~16.3), 41.5(35.0~49.0) and 19.0(16.0~22.5)days, respectively. For 52 recipients of allo-HSCT from ABO-incompatible donors, the ABO blood group conversion was initiated at 28.0(22.5~44.0)days posttransplantation and completed at 105.5(85.0~141.8)days. In the ABO-compatible group, the time of erythrocyte implantation was shortened(P<0.05), and less RBC/platelet transfusions were required as compared with the ABO major and bidirectional incompatible group, except for the time of granulocyte and megakaryoblast implantation(P>0.05), no significant difference was observed between these two variables. The blood group conversion time, implantation time of granulocyte/erythrocyte/megakaryoblast, and RBC/platelet transfusions among ABO major, minor and bidirectional incompatible groups were not significant different(P>0.05).Conclusion ABO-compatiblity enjoys priority in allo-HSCT. ABO-incompatiblity can be chosen in the order of minor, major and bidirectional incompatibility in the absence of ABO-compatiblity.