Rh D alloimmunization in allogeneic HSCT

摘要

Incompatibility between donor and recipient for the Rhesus D (Rh D) red cell antigen occurs commonly in the setting of allogeneic hematopoietic SCT. Donor-derived immune reactions against host antigens or host immunity that persists despite the conditioning treatment may compromise the success of allogeneic transplantation. When such immune reactions involve RBC antigens, transfusion therapy for the patient may be complicated. Moreover, immunological tolerance between host and recipient occurs more gradually and may remain incomplete following reduced-intensity conditioning (RIC) compared with myeloablative regimens, and it remains unclear if alloimmunization occurs more commonly following Rh D-incompatible transplants in the RIC setting. Previous reports describe only occasional instances of Rh D alloimmunization after Rh D-incompatible transplants. We recently encountered a case of persistent anti-Rh D alloimmunization following allogeneic hematopoietic SCT, and reviewed our institutional experience for patients undergoing myeloablative conditioning and RIC allogeneic hematopoietic SCT to gain current insight regarding the incidence and potential clinical significance of Rh D alloimmunization in this setting.