1986 Volume 27 Issue 1 Pages 22-29
Six patients with acute leukemia or chronic myelocytic leukemia received allogeneic bone marrow transplantations (BMTs) from major ABO-incompatible siblings by removing incompatible erythrocytes from the aspirated donor marrow. After erythrocyte depletion using Hemonetics blood processor, sixty-eight percent of the original nuclear cells recovered contained 58% of the CFU-E, 57% of the BFU-E and 48% of the CFU-GM. Furthermore, in vitro assay of committed progenitor cells showed that though recipient's serum with complement inhibited the growth of the marrow donor's CFU-E, it failed to inhibit the growth of the BFU-E and CFU-GM. Clinically there was no significant acute hemolytic reaction. All six patients were successfully engrafted and rate of recovery of peripheral blood granulocytes, reticulocytes and platelets was similar to that observed in ABO-compatible marrow transplanted patients. This erythrocyte purging technique is thought to be safe and effective to perform major ABO-incompatible BMT.
One patient of group A, who was transplanted with group B bone marrow had a delayed immune hemolysis of recipient's red cells. Nine days following BMT the patient experienced a chill, temperature elevation with hemoglobinuria and a drop in hemoglobin level in spite of transfusion of group O RBC. The direct antiglobulin test was positive with C3. Isohemagglutinin titers of IgM- and IgG anti-A were elevated from zero to ×64 and ×4, respectively. As the patient did not have incompatible plasma, these anti-A antibodies were thought to be produced by immunocompetant transplanted donor lymphocytes.
