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Persistence of recipient plasma cells and anti‐donor isohaemagglutinins in patients with delayed donor erythropoiesis after major ABO incompatible non‐myeloablative haematopoietic cell transplantation
Author(s) -
Griffith L. M.,
McCoy J. P.,
Bolan C. D.,
Stroncek D. F.,
Pickett A. C.,
Linton G. F.,
Lundqvist A.,
Srinivasan R.,
Leitman S. F.,
Childs R. W.
Publication year - 2005
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.2005.05364.x
Subject(s) - abo blood group system , haematopoiesis , erythropoiesis , immunology , transplantation , persistence (discontinuity) , hematopoietic cell , medicine , stem cell , biology , anemia , genetics , geotechnical engineering , engineering
Summary Delayed donor erythropoiesis and pure red‐cell aplasia (PRCA) complicate major‐ABO mismatched non‐myeloablative allogeneic stem‐cell transplantation. To characterize these events, we analysed red‐cell serology and chimaerism in lymphohaematopoietic lineages, including plasma cells and B cells, in 12 consecutive major‐ABO incompatible transplants following cyclophosphamide/fludarabine‐based conditioning. Donor erythropoiesis was delayed to more than 100 days in nine (75%) patients including six (50%) who developed PRCA. During PRCA, all patients had persistent anti‐donor isohaemagglutinins and recipient plasma cells (5–42%), while myeloid and T cells were completely donor in origin. In contrast, B‐cell chimaerism was frequently full‐donor when significant anti‐donor isohaemagglutinins persisted. Four patients with early mixed haematopoietic chimaerism and the prolonged presence of anti‐donor isohaemagglutinins and recipient plasma cells developed delayed‐onset (>100 days post‐transplant) red cell transfusion dependence and PRCA after myeloid chimaerism converted from mixed to full donor. These findings confirm that donor‐erythropoiesis is impacted by temporal disparities in donor immune‐mediated eradication of recipient lymphohaematopoietic cells during major‐ABO incompatibility and suggest that plasma cells are relatively resistant to graft‐ versus ‐host haematopoietic effects.