 |
关键词：骨髓移植，异基因，ABO血型不合；再生障碍，纯红细胞；抗体滴度
【摘要 】目的探讨HLA相合，ABO血型不合的异基因骨髓移植(allo-MT)中存在的免疫及造血问题。方法对本所38例ABO血型主要不合，23例次要不合的HLA相合的allo-MT受者进行分析，并选用同期ABO血型相合的allo-MT患者作配对比较。结果ABO血型不合的allo-MT患者，输注骨髓后无一例发生急性溶血。经配对t检验及χ2 检验，ABO血型不合对骨髓植活、血小板恢复，GVHD及5年无病生存率均无影响；在ABO血型主要不合组，红系开始恢复时间明显延迟，使红细胞输用量明显增多；其中5例患者发生纯红细胞再生障碍(纯红再障)，持续约7～24个月。发生纯红再障者均为“O”型血受者，红系恢复与血型抗体滴度具有相关性。结论ABO血型不合可以进行allo-BMT，但对发生纯红再障高危的患者宜慎重。
ABO-incompatible allogeneic bone marrowtransplantation
XU Lanping, GUO Nailan, WANG Suqin, et al. Instituteof Hematology, People's Hospital, Beijing Medical Univercity, Beijing 100044
【Abstract 】 Objective To explore theimmunohematological problems in ABO incompatible allogeneic bone marrow transplantation (allo BMT). Methods Among 250 HLA matched allo BMTs, 61 were performed betweenABO incompatible siblings. Out of these 61 BMTs, 38 were major ABO incompatible and 23,minor. Control group included 61 HLA matched Allo BMTs with ABO compatible grafts.The major ABO incompatible patients received marrow grafts depleted of erythrocytes byhydroxyethyl starch (HES) sedimentation. The minor or bidirectional received marrow graftsdepleted of plasma to reduce anti A or anti B agglutinins. ABO antigen and antibodyin the recipients sera were determined once a week. Results ABO incompatible grafts forBMT had no adverse effect on engraftment, recovery of platelets, incidence of GVHD orsurvival. No recipient developed clinically hemolysis during or after marrow infusion. InABO major compatible group, the onset of erythropoiesis after BMT was delayed and more RBCtransfusions were required. Five of 10 recipients with blood group “ O" in thisgroup developed pure red cell aplasia (PRCA), lasting 7～ 24 months. Two of themrecovered without therapeutic intervention. In the PRCA patients, the RBC antibody titersremained high for a longer time after BMT than in those whose erythropoiesis reconstitutedtimely. Serious morbidity related to ABO incompatibility did not occur. Conclusion ABOincompatible allo BMT is fairly safe if there is indication, however, PRCA may developin isolated cases.
......
您现在查看是摘要页，全文长 19357 字符。