Effect Of ABO Blood Group Incompatibility On Allogeneic Hematopoietic Stem Cell Transplantation In Patients With β-thalassemia Major

Objective: to explore the recovery of hematopoietic function,needs of erythrocyte transfusion,pure red cell aplastic anemia(PRCA)and prognosis in patients with β-thalassemia major(β-TM)with ABO blood group incompatibility between donors and recipients after transplantation,so as to provide more experience for clinical work and better improve the quality of life of the patients.Methods: We retrospectively analyzed the clinical data of 504 patients with β-TM who underwent allogeneic hematopoietic stem cell transplantation(AlloHSCT)in our hospital from December 2007 to August 2019.A total of 294(58.3%)donor-recipient pairs were ABO blood group compatibility,210(58.3%)donorrecipient pairs were ABO blood group incompatibility.There were 86(41.0%)had a major ABO incompatibility,87(41.4%)had a minor ABO incompatibility,and37(17.6%)had a bidirectional ABO incompatibility in the ABO blood group incompatibility.Results: Except for 3 patients of graft failure,the time of engraftment could not be judged in 5 cases of early death after transplantation,all of the other 496 patients were engrafted.The median time of neutrophil and platelet engraftment was + 11 days(+ 8～32 days)and + 15 days(+ 8～66 days),respectively.There was no significant difference in neutrophil and platelet engraftment after transplantation between ABO blood group compatibility and ABO blood group incompatibility(P = 0.172,P = 0.105).Subgroup analysis shows that there was no significant difference in the time of neutrophil and platelet engraftment among the four groups(P=0.126、P=0.226).The median total amount of erythrocyte transfusion after transplantation was 4.0 U(0U～97.0U).Compared with ABO blood group compatibility and ABO blood group incompatibility,there was significant difference in the total amount of erythrocyte transfusion between the two groups after transplantation(P=0.001).Subgroup analysis shows that patients with major ABO incompatibility and bidirectional ABO incompatibility required significantly more erythrocyte transfusion after transplantation compared to patients with ABO blood group compatibility(P=0.000、P=0.001).The incidence of PRCA was 1.2%,and it healed after infusion of red blood cells.All patients in our study were followed up to February 2020,and a total of 467 patients survived,with a survival rate of 92.7%.The median follow-up time after transplantation was 38.5 months(range,1to 146 months).There was no significant difference in overall survival(OS)and disease-free survival(DFS)after transplantation between ABO blood group compatibility and ABO blood group incompatibility(P=0.583,P=0.690).Subgroup analysis shows that there was no significant difference between OS and DFS in 4 groups after transplantation(P=0.776、P=0.780).Univariate analysis showed that ABO incompatibility was not related to OS and DFS.Conclusions: 1.The ABO incompatibility of donor and recipient had no effect on neutrophil and platelet engraftment after transplantation in β-TM patients receiving Allo-HSCT.2.The ABO incompatibility of donors and recipients can lead to increased erythrocyte transfusion after transplantation for β-TM patients receiving Allo-HSCT.3.ABO blood group incompatibility between donor and recipient does not affect OS and DFS after β-TM transplantation of Allo-HSCT.