391 Minor ABO Incompatibility Does Not Impact Non-Relapse Mortality in T-Cell Depleted HLA-Matched Sibling Transplantation

Track: Poster Abstracts
Saturday, February 14, 2015, 6:45 PM-7:45 PM
Grand Hall CD (Manchester Grand Hyatt)
Puja D Chokshi, MD , Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
Prathima Anandi, MD , Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
Natasha A Jain, MD , Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
Neil Dunavin, MD , Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
Robert Q Le, MD, Phd , Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
Sawa Ito, MD , Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
A. John Barrett, MD , Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
Minoo Battiwalla, MD, MS , Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
Presentation recording not available for download or distribution as requested by the presenting author.

Introduction: ABO incompatibility (ABO-I) in allogeneic stem cell transplantation is known to produce hemolytic complications including acute hemolysis, the passenger lymphocyte syndrome, delayed transfusion dependence and pure red cell aplasia. Hemolysis is a consequence of ABO expression on red blood cells (RBCs) and the natural occurrence of isohemagglutinins. However, ABO antigens are also expressed on tissues other than RBCs such as endothelial cells. It is plausible that donor vs recipient (Minor) ABO-I may adversely impact organ function and survival after transplantation. Indeed, in contrast to historic data, one report found that ABO-I increased non-relapse mortality (NRM) in reduced intensity transplantation (Resnick et al., BBMT 2008). We conducted a large retrospective study to evaluate the hypothesis that Minor ABO-I impacts overall survival (OS) and NRM in allogeneic stem cell transplantation.

Patients and Methods: We analyzed 374 patients who had undergone allogeneic transplants for hematologic malignancies from HLA-matched sibling donors between the years 1993–2014. 71 patients had either Minor (including bidirectional) ABO-I, 55 patients had Major (recipient vs donor) ABO-I, and 248 patients had no ABO-I. The median age at transplantation was 38 years. 162 (43%) had AML/MDS, 120 (32%) had CML/CMMoL, 63 (17%) had ALL, 18 (5%) had NHL/CLL and 14 (4%) had other diagnoses. 344 (92%) received a Cytoxan/TBI-based myeloablative conditioning and 30 (8%) received reduced intensity conditioning.  The graft source was either peripheral blood stem cells in 336 (90%) or bone marrow in 38 (10%) and was ex vivo T cell depleted in 99%. There were no significant differences between Minor ABO-I and other groups with respect to baseline variables. Kaplan-Meier estimates were used to determine OS, NRM and cumulative incidence of relapse, with differences between groups determined by the log-rank test.

Results:  At a median follow up duration of 11 years, the OS for Minor/bi ABO-I was 43% vs 40% for others (p=0.8). NRM was 38% for Minor/bi ABO-I vs 42% for others (p=0.6). The cumulative incidence of relapse was 58% for Minor/bi ABO-I vs 50% for others (p=0.1). Findings were similar when ABO-I status was categorized into three groups (Major, Minor/bi vs No ABO-I).

Conclusion: In this large study of mostly myeloablative, T-cell deplete, allogeneic transplant patients the presence of donor vs recipient Minor ABO-I did not significantly impact critical long term outcomes.

 

Disclosures:
Nothing To Disclose
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