Clin Oncol | Volume 7, Issue 1 | Research Article | Open Access

ABO Isoagglutinin Levels in Management of ABO Incompatibility in Allogeneic Hematopoietic Cell Transplantation

Eleni Gavriilaki1,2*, Ioanna Sakellari1, Anastasia Konstantinou1, Despina Mallouri1, Zoi Bousiou1, Sofia Tagara1, Marianna Masmanidou1, Ioannis Batsis1, Athanasios Anastasiadis2, Christos Dontsos3, Gerasimos Bamichas3, Maria Gkanidou2 and Achilles Anagnostopoulos1

1BMT Unit, G. Papanicolaou Hospital, Greece
2Department of Transfusion, G. Papanicolaou Hospital, Greece
3Department of Nephrology, G. Papanicolaou Hospital, Greece

*Correspondance to: Eleni Gavriilaki 

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Background: Despite renewed interest in ABO isoagglutinin levels post allogeneic Hematopoietic Cell Transplantation (alloHCT), relevant studies are scarce. We investigated the impact of ABO isoagglutinins on management of ABO incompatibility.
Materials and Methods: We prospectively enrolled consecutive alloHCT recipients since we started ABO isoagglutinin measurement (2014-2019) and compared them with a historical control group (2001-2013).
Results: Among 645 alloHCT recipients, 147 (23%) had ABO incompatibility. Incidence of ABO incompatibility did not differ between treatment periods (21% vs. 26%). PRCA developed in 29 patients at a median of 32 (24-115) post-transplant day; 23 in the early and 6 in the late period (p=0.012). Among pre-transplant factors, treatment period (p=0.003) and major incompatibility
(p<0.001) independently predicted higher rates of PRCA. Isoagglutinin titers of 512 or higher were associated with the development of PRCA (p<0.001) that required plasma exchange in all, but one cases (p=0.023). With a follow-up of 184 months (5-228) in surviving patients, our real-world data in a large cohort of HCT recipients confirm previous reports that ABO incompatibility does not affect outcomes, irrespectively of transplant characteristics. Discussion: ABO incompatibility is not a risk factor for adverse outcomes. ABO isoagglutinin levels emerge as a helpful tool in guiding proper diagnosis and management in these patients.


Isoagglutinin, ABO incompatibility, Pure red cell aplasia; alloHCT


Gavriilaki E, Sakellari I, Konstantinou A, Mallouri D, Bousiou Z, Tagara S, et al. ABO Isoagglutinin Levels in Management of ABO Incompatibility in Allogeneic Hematopoietic Cell Transplantation. Clin Oncol. 2022;7:1892..

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