Red blood cell alloimmunization in 184 patients with myeloid neoplasms treated with azacitidine - A retrospective single center experience

- RBC-alloimmunization is common in patients with myeloid malignancies.
- It can lead to shortage in blood supply and hemolytic transfusion reactions.
- It is associated with the number of transfused RBC-units and time under transfusion.
- Residual RBCs in PLT units potentially cause RBC-alloimmunization.
- RBC-alloimmunization had no negative impact on patient survival in our cohort.

Alloimmunization to Red Blood Cell (RBC) antigens frequently occurs in patients with myeloid neoplasms (AML, MDS and CMML) and potentially poses the patient at risk for delayed hemolytic transfusion reactions and limited supply of compatible RBC-units. However, there is comparatively little data on transfusion associated characteristics in this patient cohort. We therefore retrospectively analyzed transfusion requirements and clinical outcomes of 184 patients with myloid neoplasms treated with azacitidine at the Paracelsus Medical University Salzburg, which were included in the Austrian Registry of Hypomethylating Agents.The mean blood component requirements for AML, MDS and CMML were 39.8, 67.4 and 31.4 RBC units and 31.7, 27.6 and 19.1 platelet (PLT) units respectively. In spite of an extended and stringent RBC unit matching policy (ABO, RhD, RhCcEe and K antigens), 20 (11%) patients formed at least one alloantibody (“allo-group”), whereas 164 patients (89%) did not (“non-allo-group”). The most frequent antibody specificity was anti-E, followed by anti-Wra −Lua, −D, −C and −Jka. Alloimmunization was associated with higher numbers of transfused RBC units (68 vs. 38; p = 0.001), as well as with longer time under transfusion (16.7 vs. 9.4 months; p = 0.014). Median overall survival (OS) did not differ significantly between the “allo”- and “non-allo-group”.