Se-Ryeon Lee; Deok-Hwan Yang; Je-Jung Lee; Yeo-Kyeoung Kim; Sang-Hee Cho; Ik-Joo Chung; Hyeoung-Joon Kim

doi:10.5045/kjh.2005.40.4.254

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Lee, Yang, Lee, Kim, Cho, Chung, and Kim: The Feasibility and Clinical Efficacy of In Vivo Adsorption of Isohemagglutinins with Fresh Frozen Plasma (FFP) Infusion in Major ABO‐incompatible Allogeneic Stem Cell Transplantation

Original Article

Korean J Hematol 2005;40(4):254-260.

Published online: 21 December 2005

DOI: https://doi.org/10.5045/kjh.2005.40.4.254

The Feasibility and Clinical Efficacy of In Vivo Adsorption of Isohemagglutinins with Fresh Frozen Plasma (FFP) Infusion in Major ABO‐incompatible Allogeneic Stem Cell Transplantation

Se-Ryeon Lee, M.D.^1,², Deok-Hwan Yang, M.D.^1,², Je-Jung Lee, M.D.^1,², Yeo-Kyeoung Kim, M.D.^1,², Sang-Hee Cho, M.D.^1,², Ik-Joo Chung, M.D.^1,², Hyeoung-Joon Kim, M.D.^1,²

¹Blood and Marrow Transplant Center, Chonnam National University Hwasun Hospital, Jeonnam, Korea

²Genome Research Center for Hematopoietic Diseases, Chonnam National University Hwasun Hospital, Jeonnam, Korea

Correspondence to: Hyeoung Joon Kim, M.D. Department of Hematology/Oncology, Chonnam National University Hwasun Hospital 160, Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeonnam 519-809, Korea Tel: +82-61-379-7637, Fax: +82-61-379-7628 E-mail: hjoonk@chonnam.ac.kr

Received 10 October 2005 Revised 15 November 2005 Accepted 21 November 2005

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

We evaluated the efficacy and feasibility of performing prolonged donor type fresh frozen plasma (FFP) infusion for the in vivo adsorption of isohemagglutinins (IHGs) in major ABO-incompatible allogeneic stem cell transplantation.

Methods

Forty-five patients underwent allogeneic stem cell transplantation. Major ABO incompatibility was observed in 23 patients. 18 patients of these 23 patients had IHGs directed towards the donor ABO antigens and they received donor type FFP; in 5 patients, the bone marrow grafts were minor incompatible; in 17 patients, the grafts were compatible.

Results

The engraftment times of the granulocytes and platelets and the transfusion requirements for red blood cells in the FFP-transfused recipients of the major ABO-incompatible allografts were not different from those of therecipients of ABO-compatible allografts (P＞0.1) and these factors were not different from those for the FFP-treated recipients of the major ABO-incompatible allografts. The median duration of FFP infusion and the number of FFP units were 23.5 days (range 8～39) and 47 units (range 16～78), respectively. The median IgG titers decreased from 1: 64 to 1: 4 over a median of 22.5 days (range 8～36) in the FFP-treated groups, compared with a median of 61 days (range 19～116) in the non-FFP-treated groups.

Conclusion

The infusion of donor-type FFP with red cell depletion represents a more feasible, effective alternative strategy to achieve in vivo immunoadsorption of IHGs and to prevent late immunohematologic complications.

Keywords: Fresh frozen plasma, Isohemagglutinins, Major ABO incompatible bone marrow transplantation

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Table 1.

Pre‐transplant patient's deomographics

	Major ABO‐ incompatibility, not FFP‐treated, N=5 (%)	Major ABO‐ incompatibility, FFP‐treated, N=18(%)	Minor ABO‐ Incompatibility, N=5 (%)	No ABO‐ Incompatibility, N=17 (%)
Age, median (range)	38 (25～43)	34 (16～46)	34 (20～43)	35 (18～44)
Sex Male/Female	1/4	10/8	2/3	12/5
Primary disease
Acute leukemia	2 (40.0)	12 (66.7)	3 (60)	9 (53)
SAA	2 (40.0)	6 (33.3)	2 (40)	4 (23.5)
CML	0	0	0	2 (11.8)
Others	1 (20.0)	0	0	2 (11.8)
Conditioning regimen
CyTBI	2 (40.0)	11 (61.1)	2 (40)	11 (64.7)
CyATG	2 (40.0)	6 (33.3)	2 (40)	4 (23.5)
BUCy	1 (20.0)	1 (5.6)	1 (20)	2 (11.8)

Abbreviations: FFP, fresh frozen plasma; SAA, severe aplastic anemia; CML, chronic myelogenous leukemia; CyTBI, cytoxan+total body irradiation; CyATG, cyclophosphamide+antithymocyte globulin; BUCy, busulfan+cytoxan.

Table 2.

Clinical outcomes of engraftment and transfusion requirements

	Major ABO‐ incompatibility, not FFP‐treated	Major ABO‐ incompatibility, FFP‐treated	Minor ABO‐ incompatibility	No ABO‐ Incompatibility
Number of patients	5	18	5	17
Days to ANC＞500/μL Median (range)	15 (14～19)	14.5 (11～21)	15 (13～18)	16 (9～18)
Days to ANC＞1,000/μL Median (range)	16 (15～20)	16.5 (13～36)	18 (15～21)	17 (12～30)
Days to Platelets＞20,000/μ Median (range)	19 (12～23)	18 (13～30)	19 (16～21)	13 (0～30)
Days to Platelets＞50,000/μ Median (range)	22 (20～39)	24 (12～35)	25 (23～28)	22.5 (12～39)
RBC units transfused Median (range)	10 (6～34)	6 (0～18)	5 (2～6)	4 (0～8)
Platelet units transfused Median (range)	11 (4～29)	5 (2～12)	9 (6～10)	6 (3～11)

Table 3.

Comparison of ABO‐incompatible allografts

	Not FFP‐treated (N=5)	FFP‐treated (N=18)
Initial IgG titer, Median (range)	1: 128	1: 64
	(1: 2～1: 256)	(1: 4～1: 1,024)
Final IgG titer, Median (range)	1: 8	1: 2
	(1: 1～1: 32)	(1: 1～1: 64)
Days between initial, final titers Median (range)	61.0	22.5
Days between initial, final titers Median (range)	(19～116)	(8～36)
Number of FFP units transfused Median (range)
Number of FFP units transfused Median (range)	N/A^∗	47 (16～78)
Days of FFP treatment Median (range)	N/A^∗	23.5 (8～39)
Delayed hemolysis (%)	2 (40)	1 (5.6)

^∗ Not analyzed.

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