Allogeneic peripheral blood hematopoietic stem cell transplantation: guidelines for red blood cell immuno-hematological assessment and transfusion practice

Allogeneic peripheral blood hematopoietic stem cell transplantation (PBSCT) is presently being evaluated in a French randomized study comparing periph eral blood vs bone marrow. Cases of potentially lethal acute hemolysis have recently been reported after allogeneic PBSCT in the presence of a 'minor' ABO incompatibility. Patients were frequently transfused with recipient-co mpatible and donor-incompatible RBC and usually did not receive methotrexat e in addition to cyclosporin A for graft-versus-host disease (GVHD) prophyl axis. In order to homogenize immuno-hematological (IH) assessment and trans fusion practices within our protocol, we made proposals to 25 allo-transpla nt French centers on the following aspects: pre-inclusion IH assessment, IH exclusion criteria, transfusion rules, post-transplant IH surveillance and treatment of hemolysis. Analysis of responses to our proposals led to the elaboration of guidelines which were approved and implemented by the French Bone Marrow Transplantation Society (SFGM). Pre-inclusion IH testing inclu des mandatory detection and titration of anti-RBC allo-Ab, as well as titra tion of anti-A and anti-B Ab. The presence in the donor of an anti-a (group A or AB recipients), anti-B (group B or AB recipients) Ab with a titer > 1 /32 or the presence of allo-Ab against Ph, Kell, Fya, Fyb, Jka, Jkb, Ss Ag present on recipient RBC is an exclusion criterion for the protocol. ABO an d RhD compatibility of RBC blood products with both HSC donor and recipient is mandatory. A similar compatibility is also required for Rh (other than D) and Kell Ag. If not possible, compatibility of RBC blood products with t he HSC donor is mandatory. Lastly, guidelines regarding post-transplantatio n IH follow-up as well as acute hemolysis treatment have been elaborated. T he implementation of these guidelines should contribute to enhancing the qu ality of transfusion practice after PBSCT. Such an approach will be applied to other aspects of transfusion medicine in the setting of HSC transplanta tion.