Low incidence of red cell and HLA antibody formation by bone marrow transplant patients
Low incidence of red cell and HLA antibody formation by bone marrow transplant patients
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DOI：
10.1046/j.1537-2995.1995.351196110898.x
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发表时间：
1995-11-01
期刊：
影响因子：
2.9
通讯作者：
Hillyer, CD
中科院分区：
文献类型：
--
作者：
AbouElella, AA;Camarillo, TA;Hillyer, CD
背景：骨髓移植 (BMT) 患者虽然免疫抑制，但仍面临产生红细胞 (RBC) 和 HLA 抗体的风险，因此通常会给予他们过滤后的血液以预防后一种并发症。本研究试图确定该患者群体中红细胞和 HLA 同种抗体的形成率和特异性。 研究设计和方法：为期 18 个月的 BMT 患者（148 名接受自体骨髓；45 名接受同种异体骨髓），包括患有白血病（57 名患者）、淋巴瘤（54 名）、乳腺癌（68 名）、骨髓瘤（8 名）、骨髓增生异常综合征（5 名）和研究再生障碍性贫血 (1) 以确定针对 RBC 和 HLA 抗原的同种抗体形成率。总共进行了 2410 次 RBC 抗体筛选。患者接受了 3921 个浓缩红细胞和 5915 个单供体血小板单位；所有患者均经过辐射并通过白细胞还原过滤器给药。结果：193 名患者中有 7 名 (3.6%) 入院时出现红细胞抗体。 193 名患者中有 4 名 (2.1%) 在 BMT 过程中产生了红细胞抗体：3 名患者有一种红细胞抗体，1 名患者有两种红细胞抗体。 RBC 抗体包括抗 E (n = 2)、抗 M (n = 1)、抗 Jk(b) (n = 1) 和抗 Lu14 (n = 1)。因此，98% 的患者 (189/193) 在 BMT 期间没有产生新的 (182/186) 或额外的 (7/7) 红细胞抗体。 BMT 患者还每周接受一次 HLA 抗体形成筛查（60 细胞组）。入院时，170 名患者（85%）的检测结果呈阴性。其中，8 例 (4.7%) 产生持久性 HLA 抗体（平均组反应性抗体评分，33 +/- 29%），9 例 (5.3%) 呈不同程度的阳性。因此，在我们的环境和人群中，每单位输血的 RBC 抗体形成率为 0.1%，HLA 同种免疫率为 5% 至 10%。 结论：由于 BMT 服务每周一、周三和周五进行 RBC 抗体筛查，并且这些患者的 RBC 抗体形成率较低，因此可能不太频繁地筛查意外抗体。此外，接受过滤血液成分的人群中 HLA 同种免疫率较低。
Background: Bone marrow transplant (BMT) patients, although immunosuppressed, are at risk for the development of red cell (RBC) and HLA antibodies, and they often are given filtered blood in an effort to prevent the latter complication. This study attempts to determine the rate of formation and the specificity of both RBC and HLA alloantibodies in this patient population.Study Design and Methods: BMT patients (148 received autologous marrow; 45 received allogeneic marrow) from an 18-month period, including patients with leukemia (57 patients), lymphoma (54), breast cancer (68), myeloma (8), myelodysplastic syndrome (5), and aplastic anemia (1), were studied to determine the rate of alloantibody formation to RBC and HLA antigens. A total of 2410 RBC antibody screens were performed. The patients received 3921 packed RBCs and 5915 single-donor platelet units; all were irradiated and administered via white cell-reduction filters.Results: Seven (3.6%) of 193 patients had RBC antibodies upon hospital admission. Four (2.1%) of 193 developed RBC antibodies during the course of BMT: 3 patients had one RBC antibody and 1 patient had two RBC antibodies. RBC antibodies included anti-E (n = 2), anti M (n = 1), anti-Jk(b) (n = 1), and anti-Lu14 (n = 1). Thus, 98 percent of patients (189/193) did not develop new (182/186) or additional (7/7) RBC antibodies during BMT. BMT patients were also screened weekly for HLA antibody formation (60-cell panel). Upon admission, 170 (85%) patients were negative. Of these, 8 (4.7%) developed persistent HLA antibodies (mean panel-reactive antibody score, 33 +/- 29%) and 9 (5.3%) were variably positive. Thus, in our setting and population, RBC antibody formation was 0.1 percent per unit transfused, an the HLA alloimmunization rate was 5 to 10 percent.Conclusion: As RBC antibody screens are done every Monday, Wednesday, and Friday on this BMT service and as RBC antibody formation is low in these patients, screening for unexpected antibodies might be possible on a more infrequent basis. Also, the rate of HLA alloimmunization in this population receiving filtered blood components is low.