School of Medicine and Health Sciences Poster Presentations

Title

The Significance of Red Blood Cell Antigen Matching on Bone Marrow Transplant Outcomes in Patients with Sickle Cell Disease

Poster Number

171

Document Type

Poster

Publication Date

3-2016

Abstract

Background: Hematopoietic stem cell transplant (HSCT) is the only potential curative therapy for sickle cell disease (SCD) currently. While significant research has been performed on the clinical impact of ABO-incompatible HSCT in patients with SCD, only preliminary studies have analyzed the outcomes of HSCT with non-ABO red blood cell (RBC) antigen discordance.

Objectives: To investigate the frequency and clinical significance of minor RBC antigen discordance on HSCT outcomes in patients with SCD.

Design/Methods: This study is a retrospective analysis of a cohort of patients with SCD who received a HSCT from 1995 to 2015, at a single institution.

Results: Of the 48 patients with SCD who received HSCT, 17 (35.4%) had available data on minor RBC antigens for both donor and recipient. All 17 patients received transplants from HLA and ABO-matched related donors. There were 52.9% males, 88.2% African Americans, and mean age at time of transplant was 8.4 years old. Several different conditioning regimens were used, including reduced intensity regimens. The primary indications for transplant were history of stroke (47%), vasoocclusive crisis (29.4%), and acute chest syndrome (17.6%). Prior to transplant, alloantibodies were present in 35.3% of the subjects, the majority being anti-Rhesus-C.

The majority of patients (94.1%) had at least 1 minor RBC antigen discordant with their donor. Fourteen patients (82.4%) had 1-3 discordances. The most common discordant blood group systems were the Rhesus (47%), MNS (35.3%), and Dombrock (29.4%) systems. None of the subjects developed novel antibodies following HSCT, despite discordances.

Overall, there was little correlation between the number of minor RBC antigen discordances and HSCT outcomes (overall survival, graft failure, transfusion requirements, time to engraftment, time to transfusion independence, and complications). However, patients with two or more minor RBC discordances appeared to have more chronic GvHD, while patients with one discordance were more likely to develop acute GvHD.

Conclusions: There appeared to be a trend towards increasing cGVHD in patients who had greater numbers of discordant minor RBC antigens, but no other association with clinical HSCT outcomes; however, given the limited size of this cohort, further studies are required.

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Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Open Access

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Presented at: GW Research Days 2016

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The Significance of Red Blood Cell Antigen Matching on Bone Marrow Transplant Outcomes in Patients with Sickle Cell Disease

Background: Hematopoietic stem cell transplant (HSCT) is the only potential curative therapy for sickle cell disease (SCD) currently. While significant research has been performed on the clinical impact of ABO-incompatible HSCT in patients with SCD, only preliminary studies have analyzed the outcomes of HSCT with non-ABO red blood cell (RBC) antigen discordance.

Objectives: To investigate the frequency and clinical significance of minor RBC antigen discordance on HSCT outcomes in patients with SCD.

Design/Methods: This study is a retrospective analysis of a cohort of patients with SCD who received a HSCT from 1995 to 2015, at a single institution.

Results: Of the 48 patients with SCD who received HSCT, 17 (35.4%) had available data on minor RBC antigens for both donor and recipient. All 17 patients received transplants from HLA and ABO-matched related donors. There were 52.9% males, 88.2% African Americans, and mean age at time of transplant was 8.4 years old. Several different conditioning regimens were used, including reduced intensity regimens. The primary indications for transplant were history of stroke (47%), vasoocclusive crisis (29.4%), and acute chest syndrome (17.6%). Prior to transplant, alloantibodies were present in 35.3% of the subjects, the majority being anti-Rhesus-C.

The majority of patients (94.1%) had at least 1 minor RBC antigen discordant with their donor. Fourteen patients (82.4%) had 1-3 discordances. The most common discordant blood group systems were the Rhesus (47%), MNS (35.3%), and Dombrock (29.4%) systems. None of the subjects developed novel antibodies following HSCT, despite discordances.

Overall, there was little correlation between the number of minor RBC antigen discordances and HSCT outcomes (overall survival, graft failure, transfusion requirements, time to engraftment, time to transfusion independence, and complications). However, patients with two or more minor RBC discordances appeared to have more chronic GvHD, while patients with one discordance were more likely to develop acute GvHD.

Conclusions: There appeared to be a trend towards increasing cGVHD in patients who had greater numbers of discordant minor RBC antigens, but no other association with clinical HSCT outcomes; however, given the limited size of this cohort, further studies are required.