The role of pathogen-reduced platelet transfusions on HLA alloimmunization in hemato-oncological patients.
Transfusion
; 59(2): 470-481, 2019 02.
Article
en En
| MEDLINE
| ID: mdl-30499599
ABSTRACT
BACKGROUND:
Platelet transfusions can induce alloimmunization against HLA antigens. The use of pathogen-reduced platelet concentrates (PCs) was suggested to reduce HLA alloimmunization and concomitant transfusion refractoriness.METHODS:
This study investigated HLA alloimmunization in available samples from 448 hemato-oncological patients who were randomized for the Pathogen Reduction Evaluation and Predictive Analytical Rating Score (PREPAReS) trial to receive either untreated or pathogen-reduced PCs (Mirasol, Terumo BCT Inc.). Anti-HLA Class I and II antibodies were determined before the first platelet transfusion and weekly thereafter using multiplex assay with standard cutoffs to detect low- as well as high-level antibodies.RESULTS:
When using the lower cutoff, in patients who were antibody negative at enrollment, 5.4% (n = 12) developed anti-HLA Class I antibodies after receiving untreated PCs, while this was significantly higher in patients receiving pathogen-reduced PCs, 12.8% (n = 29; p = 0.009, intention-to-treat [ITT] analysis). A similar but nonsignificant trend was observed in the per-protocol (PP) analysis (5.4% vs. 10.1%; p = 0.15). HLA class II antibody formation was similar between both types of PCs in the ITT analysis, while the PP analysis showed a trend toward lower immunization after receiving pathogen-reduced PCs. Multivariate analysis identified receiving pathogen-reduced platelets as an independent risk factor for HLA Class I alloimmunization (ITT odds ratio [95% confidence interval] = 3.02 [1.42-6.51], PP odds ratio [95% confidence interval] = 2.77 [1.00-5.40]), without affecting HLA Class II alloimmunization. When using the high cutoff value, the difference in HLA Class I alloimmunization between study arms remained significant in the ITT analysis and again was not significant in the PP analysis.CONCLUSION:
Our data clearly indicate that Mirasol pathogen inactivation does not prevent HLA Class I or II alloimmunization after platelet transfusions.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Inmunización
/
Transfusión de Plaquetas
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Neoplasias Hematológicas
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Reacción a la Transfusión
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Antígenos HLA
/
Isoanticuerpos
Tipo de estudio:
Clinical_trials
/
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Aged
/
Female
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Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Transfusion
Año:
2019
Tipo del documento:
Article
País de afiliación:
Países Bajos