Effect Of HLA Matching And ABO Blood Group On Hematopoietic Stem Cell Transplantation In Children With β-thalassemia Major

Thalassemia is the most common hereditary hematological disease in children.According to different genotypes,it can be divided into the following four types:αthalassemia,β-thalassemia,δβ-thalassemia,δ-thalassemia and other rare thalassemia,among which α and β-thalassemia are the most common.Chronic hemolytic anemia is the main clinical manifestation of thalassemia.According to the severity of clinical manifestations,β-thalassemia can be divided into mild,intermediate and severe.Hematopoietic stem cell transplantation is the only radical treatment for β-thalassemia.Human leukocyte antigen(HLA)plays an important role in hematopoietic stem cell transplantation(HSCT).HLA matching is an important criterion for donor selection in HSCT.According to relevant research reports at home and abroad,HLA-matched donor is the first choice for thalassemia patients.However,many patients with severe β-thalassemia in China cannot match HLA-matched donors,they can only choose HLA-mismatched or HLA-haploidentical donors.ABO incompatibility is a contraindication in organ transplantation,but it is very common in hematopoietic stem cell transplantation.At present,there is no unified conclusion about the effect of ABO incompatibility on hematopoietic stem cell transplantation.In order to analyze the effects of HLA matching results,ABO blood groups of donors and recipients on survival status,success rate of stem cell implantation,time of hematopoietic reconstitution and incidence of complications after transplantation,257 patients with β-thalassemia major were collected from Nanfang Hospital affiliated to Guangzhou Southern Medical University from January 1,2013 to December 31,2018.The patients were divided into HLA matched group,HLA mismatched group and HLA haploidentical group.According to the ABO blood group relationship between donors and recipients,all groups were divided into blood group matching group,blood group major incompatibility group and blood group minor incompatibility group.Statistical software SPSS 20.0 was used to analyze the data.The setting of P<0.05 had statistical significance.T test or rank sum test was used for measurement data,chi square test was used for comparison between groups,chi square test was used for incidence comparison and implantation status,rank sum test was used for hematopoietic reconstitution time,and Kaplan Meier method was used to draw survival curve.Analysis of the data showed that disease-free survival rate,stem cell implantation status,incidence of graft-versus-host disease and hematopoietic reconstitution time were associated with HLA matching.The disease-free survival rate was significantly higher in the HLA matched group than in the HLA haploidentical group.Compared with HLA matched group and HLA mismatched groups,HLA haploidentical group had higher failure rate of stem cell implantation,higher incidence of graft-versus-host disease and longer time of hematopoietic reconstitution.There was no significant difference in ABO blood group relationship between donors and recipients about survival analysis,stem cell implantation,hematopoietic reconstitution time,graft-versus-host disease and infection..