Impact of Major and Bidirectional ABO Incompatibility on Outcomes of Unrelated Cord Blood Transplantation: An Analysis of 757 Cases

doi:10.3969/j.issn.1671-2587.2025.04.012

JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE ›› 2025, Vol. 27 ›› Issue (4): 518-525.DOI: 10.3969/j.issn.1671-2587.2025.04.012

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Impact of Major and Bidirectional ABO Incompatibility on Outcomes of Unrelated Cord Blood Transplantation: An Analysis of 757 Cases

ZHANG Yong¹, GENG Liangquan², QIANG Ping², FAN Qian², LIU Huilan^1,2

¹Department of Haematology, Anhui Provincial Hospital Affiliated to Anhui Medical University;
²Department of Haematology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 230000

Received:2025-04-20 Published:2025-08-22

Abstract

Abstract: Objective To investigate the impact of major and bidirectional ABO blood group incompatibility on the outcomes of unrelated cord blood transplantation (CBT). Methods This retrospective study included 757 patients who underwent unrelated CBT at the First Affiliated Hospital of the University of Science and Technology of China from January 2020 to October 2024. Based on donor-recipient ABO compatibility, patients were categorized into two groups: the major/bidirectional incompatibility group (n=312) and the compatible/minor incompatibility group (n=445). Transplantation outcomes were compared between the two groups. Results The median time to neutrophil, platelet, and red blood cell engraftment was 16 vs. 15 days (P=0.790), 37 vs. 36 days (P=0.101), and 25 vs. 21 days (P<0.05), respectively, in the major/bidirectional incompatibility group compared with the compatible/minor incompatibility group. No cases of pure red cell aplasia (PRCA) were observed in either group. The 100-day cumulative incidence of grade Ⅱ-Ⅳ and grade Ⅲ-Ⅳ acute graft-versus-host disease (aGVHD) was 30.5% vs. 28.9% (P=0.996) and 20.3% vs. 14.7% (P=0.275), respectively; the 2-year cumulative incidence of moderate-to-severe chronic GVHD (cGVHD) was 3.39% vs. 4.14% (P=0.831). The 1-year incidence of clinically significant cytomegalovirus (CMV) infection was 73.5% vs. 69.3% (P=0.316). The 2-year transplant-related mortality (TRM) and overall survival (OS) rates were 15.3% vs. 13.2% (P=0.791) and 76.9% vs. 78.3% (P=0.743), respectively. Conclusion Major and bidirectional ABO incompatibility had no significant effect on engraftment, incidence of aGVHD and cGVHD, CMV infection, TRM, or OS in CBT patients. Although red blood cell engraftment was significantly delayed in the major/bidirectional incompatibility group, no transplantation-related PRCA was observed.

Key words: Major ABO incompatibility, Unrelated cord blood transplantation, Pure red cell aplasia, Graft-versus-host disease, Cytomegalovirus infection, Transplant-related mortality, Overall survival

CLC Number:

R457
R552

ZHANG Yong, GENG Liangquan, QIANG Ping, FAN Qian, LIU Huilan. Impact of Major and Bidirectional ABO Incompatibility on Outcomes of Unrelated Cord Blood Transplantation: An Analysis of 757 Cases[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2025, 27(4): 518-525.

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Impact of Major and Bidirectional ABO Incompatibility on Outcomes of Unrelated Cord Blood Transplantation: An Analysis of 757 Cases

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