Plasma Exchange and Immunoadsorption for Removal of Antibodies Prior to ABO Incompatible Bone Marrow Transplant

ABO incompatible allogeneic bone marrow transplants can be performed successfully to treat patients with leukemia or aplastic anemia. These transplants carry no great risk of rejection or graft-versus-host disease, however, some method must be used to avoid acute hemolysis at the time of infusion of ABO incompatible marrow. We have used successfully large volume plasma exchange to remove anti-A or anti-B antibodies prior to marrow infusion. More recently we have used immunoadsorbent columns containing synthetic A or B antigen specifically to remove anti-A or anti-B antibodies in lieu of plasma exchange. These columns are better tolerated than plasma exchange where allergic reactions are common.