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Transfusion burden following reduced intensity allogeneic hematopoietic cell transplantation: Impact of donor type
Subramanian, S., Cohn, C., DeFor, T., Welbig, J., Brunstein, C., El Jurdi, N., Weisdorf, D.
Transfusion. 2021
Abstract
BACKGROUND Transfusions are essential for allogeneic hematopoietic cell transplant (HCT), yet they are influenced by graft, donor, and other factors. STUDY DESIGN We analyzed transfusions in 165 adult reduced intensity HCTs (2016-2019): HLA matched sibling donor (MSD) (n = 59), matched URD (n = 25), UCB (n = 33), and haploidentical (haplo, n = 48) detailing the cumulative incidence of platelet and RBC transfusion independence, total transfusions (day-10 to day+100) plus transfusion densities (per week) over 110?days. RESULTS Platelet recovery to 20 ×?10(9) /L by 6 months occurred in 39/48 (81.25%) haplo recipients (median 33 [range, 0-139]) days vs. 58/59 (98.3%) MSD (median 10 [0-37]), 21/25 (84%) matched URD (median 20 [0-153]), and 29/33 (87.87%) UCB (median 48 [29-166]) days, p .01. Regression analysis demonstrated a lower likelihood of prompt platelet recovery in matched URD, UCB, or haplo HCTs vs. MSD. Recovery to platelet independence was quickest in MSD (median 8?days [range 0-94]), vs. URD (median 16?days [0-99]), UCB (median 57 [0-94]), or haplo (median 45 [12-97]) days, p .01. Platelet needs were unaffected by age, conditioning, or acute GVHD. RBC transfusion independence was achieved in 78% of MSD, 64% URD, and 82% UCB, though less frequent (58%) and slowest in haplo recipients, p .01. All haplo and UCB recipients required platelet transfusions vs. only 51% of MSD and 76% of URD. RBC needs were highest in UCB and haplo HCTs. DISCUSSION The transplant donor influences the transfusion burden with greater platelet and RBC needs in haplo and UCB HCT which directly contributes to increased cost of care.
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Effect of donor type on volume of blood transfusions required after allogeneic hematopoietic cell transplantation
Kurosawa, S., Yamaguchi, T., Nakabayashi, S., Kasane, M., Tsubokura, M., Iwashita, N., Minakawa, Y., Ohtake, R., Kawamura, K., Nishioka, Y., et al
International journal of hematology. 2021
Abstract
We reviewed blood product use in 729 consecutive allogeneic hematopoietic cell transplantation (allo-HCT) recipients at our center to assess the volume of red blood cells (RBCs) and platelets required after allo-HCT. The median number of bags required by day 30 was 4 for RBCs (range 0-22) and 9.5 for platelets (0-53). Multivariate analysis showed that related peripheral blood stem cell transplantation (PBSCT) required a significantly lower RBC transfusion volume by day 30 compared to unrelated bone marrow transplantation (UBMT). PBSCT from haplo-identical related donors and cord blood transplantation (CBT) required a significantly greater RBC transfusion volume. For platelet transfusion, related and unrelated PBSCT required a significantly lower volume than UBMT, and CBT a greater volume. Other factors independently associated with greater RBC transfusion volume were male sex, disease status other than complete remission, and major ABO mismatch. For platelet transfusion, these were male sex, disease status, and HCT-specific comorbidity index of 1. Although the burden of blood transfusions may not be the most important factor when choosing a donor type, our findings may provide a foundation for nationwide strategies to prepare blood products and inform aspects of national healthcare expenditures.
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3.
Donor-type fresh frozen plasma is effective in preventing hemolytic reaction in major ABO incompatible allogeneic stem cell transplant
Quek, J., Lee, J. J., Lim, F. L., Diong, C., Goh, Y. T., Gopalakrishnan, S., Ho, A., Hwang, W., Koh, M., Loh, Y., et al
Transfusion. 2018
Abstract
BACKGROUND Hemolysis at the time of graft infusion is one of the immediate complications in major ABO-incompatible allogeneic hematopoietic stem cell transplants (HSCTs). We conducted a retrospective analysis to evaluate the efficacy of donor-type fresh frozen plasma (FFP) in reducing isohemagglutinin titer and preventing hemolysis, as well as its effect on delayed red cell engraftment. MATERIALS AND METHODS This is a single-center study on a series of 380 allogeneic HSCT between 2005 and 2015; of which 99 were either major (n = 74) or bidirectional (n = 25) ABO mismatched. Pre-transplant infusion of FFP, post-transplant complications and transfusion requirements were determined by retrospective review of individual medical records. Laboratory results were also reviewed for evidence of hemolysis and pure red cell aplasia (PRCA). RESULTS Clinical manifestation of hemolysis attributable to ABO mismatch was present in one recipient of major ABO-incompatible peripheral blood stem cell (PBSC) with a titer of 64. Another recipient of major ABO-incompatible PBSC with a titer of 64 showed biochemical evidence of hemolysis. Both patients recovered with supportive treatment. Hemolysis did not occur in any patients with titer of 32 or less at the time of stem cell infusion. We were unable to demonstrate the influence of any variables on the incidence of PRCA. CONCLUSION Our experience demonstrated that donor-type FFP is safe and effective in preventing acute hemolysis in major ABO-mismatched HSCT. We have also established the titer of 64 as the threshold that may cause hemolysis and therefore efforts should be made to reduce titer to below this level.
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Platelet transfusion refractoriness after T-cell-replete haploidentical transplantation is associated with inferior clinical outcomes
Fu, Q., Xu, L., Zhang, X., Wang, Y., Chang, Y., Liu, K., Huang, X.
Science China Life Sciences. 2017
Abstract
Haploidentical stem cell transplantation (haplo-SCT) has been an alternative source of bone marrow for patients without human leukocyte antigen (HLA)-matched donors. The aim of this study was to investigate the relationships between platelet transfusion refractoriness (PTR) and clinical outcomes in the setting of haplo-SCT. Between May 2012 and March 2014, 345 patients who underwent unmanipulated haplo-SCT were retrospectively enrolled. PTR occurred in 20.6% of all patients. Patients in the PTR group experienced higher transplant-related mortality (TRM, 43.7% vs. 13.5%, P<0.001), lower overall survival (OS, 47.9% vs. 76.3%, P<0.001) and lower leukemia-free survival (LFS, 47.9% vs. 72.3%, P<0.001) compared to patients in the non-PTR group. The multivariate analysis showed that PTR was associated with TRM (P=0.002), LFS (P<0.001), and OS (P<0.001). The cumulative incidences of PTR in patients receiving >12 platelet (PLT) transfusions (third quartile of PLT transfusions) were higher than in patients receiving either >6 (second quartile) or >3 (first quartile) PLT transfusions (56.1% vs. 41.6% vs. 28.2%, respectively; P<0.001). The multivariate analysis also showed that PTR was associated with the number of PLT transfusions (P<0.001). PTR could predict poor transplant outcomes in patients who underwent haploidentical SCT.
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5.
ABO chimerism determined by real-time polymerase chain reaction analysis after ABO-incompatible haematopoietic stem cell transplantation
Liu, F., Li, G., Mao, X., Hu, L.
Blood Transfusion = Trasfusione Del Sangue. 2013;11(1):43-52
Abstract
BACKGROUND The dynamic alteration of ABO blood group in ABO-incompatible haematopoietic stem cell transplantation can be well defined by ABO chimerism analysis. In view of the intrinsic difference in ABO phenotypes or genotypes between donor and recipient in ABO incompatible transplantation, ABO allele-associated nucleotide polymorphic sites could theoretically be used as available informative markers for chimerism analysis. MATERIALS AND METHODS We chose nucleotide polymorphism sites (261, 467, 802, 803 and 1,061) of common ABO alleles to use as markers from 76 randomly chosen donors and assessed the limit of linear detection of a specifically designed real-time quantitative polymerase chain reaction using SYBR Green I dye with these sites for a chimerism assay. RESULTS We successfully established the real-time quantitative polymerase chain reaction for detecting 261, 467(mutated) and 803 sites and their limits of linear detection, which were at least 10(-3), 10(-2) and 10(-2), respectively. The limits of linear detection between heterozygous DNA and homozygous DNA with 261 or 803 sites were not significantly different. DISCUSSION ABO chimerism can be well analysed by real-time polymerase chain reaction with ABO gene-associated nucleotide polymorphic sites. This strategy could be very beneficial for the early and accurate judgement of the crucial point of transition in order to plan a safe transfusion strategy following ABO-incompatible transplantation.