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A colleague in Australia requests input regarding the role and efficacy of plasmapheresis of recipients who undergo transplantation of ABO mismatched bone marrow/PBSC. On occasion they have carried out plasmapheresis on such recipients prior to a major ABO mismatched transplantation when they did not want to red cell deplete the inoculum (BM) and hence avoid hemolysis in the initial infusion phase. Recently they were asked to consider plasmapheresis of a recipient who has high level ABO antibodies (titer >256) and delayed erythroid engraftment. The patient is a female who had a pre-transplant anti-A titer of 4096 (not plasmapheresed), but who has not showed development of erythroid lineage some 4 months post transplantation. Her anti-A titer is currently 512, which has remained stable at this level during most of the post-transplant period. This use of plasmapheresis may not address more practical dilemmas as in Matched Unrelated Donor (MUD) allograft that plasmapheresis close to stem cell reinfusion will likely remove ATG and Campath®, etc. that defeats the purposes of these medications. Other issues, like efficacy (rebound), makes the practice of plasmapheresis so variable according to surveys. The Australian would appreciate any comments and advice of other centers about the use of pre-transplantation plasmapheresis (or other approaches) when dealing with the transplantation of ABO mismatched bone marrow/PBSC, especially when the recipient has an ABO antibody titer >256. |
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Please submit comments to the e-Network Forum. Ira A. Shulman, MD W. Tait Stevens, MD |
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