A prospective randomized trial of HLA-matched versus mismatched single-donor platelet transfusions in cancer patients

Abstract

The use of histocompatability antigen (HLA)-matched platelets has been advocated for the support of thrombocytopenic cancer patients. We randomized 78 newly diagnosed cancer patients prospectively (before thrombocytopenia) to receive either HLA-matched or mismatched single-donor platelet transfusions. Three hundred forty-one platelet transfusions were given for 80 separate episodes of therapy-induced thrombocytopenia in 33 patients. Forty-five patients receiving intensive chemotherapy did not develop significant (less than 20,000 platelets/mm3) thrombocytopenia and did not receive a platelet transfusion. No marked difference was observed between the matched and mismatched groups in regard to number of total platelet transfusions per patient (median, 3 vs. 5, respectively; P = 0.076), number of platelet transfusions per episode (median, 3.0 vs. 3.5, respectively; P = 0.28), or days between transfusions (median, 2 vs. 2, respectively, P greater than 0.4). Bleeding episodes, although rare, tended to be of increased severity in the mismatched group. Febrile patients receiving mismatched platelets tended to have a lower posttransfusion increment increase than their nonfebrile counterparts (P = 0.068), although a similar trend could not be demonstrated between febrile and nonfebrile patients who received matched platelets (P = 0.22). Patients treated as outpatients had significantly higher posttransfusion increments than when transfused as inpatients when they were given mismatched platelets (P less than 0.0005). Development of antiplatelet antibody did not appear to affect response to platelet transfusions. Only one patient developed sustained high-level antibody titers. In patients where thrombocytopenia was significant, the transfusion of HLA-matched platelets did not appear to offer a significant advantage. However, HLA-matched platelet transfusions tended to be associated with higher posttransfusion increments in febrile patients and a trend toward fewer severe bleeding episodes. A multi-institution trial containing a large number of patients is needed to evaluate trends observed in this study.

Efficacy of HLA‐matched platelet transfusions for patients with hypoproliferative thrombocytopenia: a systematic review

“…The single‐center study randomized 78 patients with nonrefractory hypoproliferative thrombocytopenia of whom 33 received PLT transfusion and were analyzed (Tables and ; http://onlinelibrary.wiley.com/doi/10.1111/trf.12175/suppinfo, available as supporting information in the online version of this paper) . Patients received nonleukoreduced irradiated products.…”

“…The single-center study randomized 78 patients with nonrefractory hypoproliferative thrombocytopenia of whom 33 received PLT transfusion and were analyzed ( Tables 1 and 2; Table S1, available as supporting information in the online version of this paper). 23 Patients received nonleukoreduced irradiated products. The assessment of bleeding was not standardized a priori and the sample size was not predetermined to assess differences in bleeding outcomes.…”

HLA alloimmunization against platelet transfusions: pathophysiology, significance, prevention and management

“…While some studies supported such practice, others failed to show a consistent benefit and the practice is not generally recommended. A randomized controlled trial that involved up‐front prophylactic HLA‐matched platelet transfusions also did not show a reduction in alloimmunization (39).…”

The top ten list of randomized controlled trials in transfusion medicine

“…Over this period, less than 100 randomized controlled trials have been done to evaluate the various Transfusion Medicine interventions used in the treatment of patients [8–72]. The focus of these randomized controlled trials have ranged widely from: studying the efficacy of platelets for the treating thrombocytopenic bleeding; evaluating the use of pathogen reduction technology on platelets to prevent bleeding in thrombocytopenic subjects; the evaluation of leucoreduction in preventing transfusion‐related immunomodulatory effects; evaluating transfusion triggers for both red blood cells or platelets; assessing the efficacy of various infectious disease markers in preventing transfusion‐transmitted infections; evaluating the role of various agents in reducing allogeneic transfusion requirements; or studying the role of allogeneic red blood cell transfusions and the postoperative length of stay at a hospital, or intensive care site [8–72].…”

“…Many of the Transfusion Medicine related reported randomized controlled trials that have been done over the past decade are listed in the references [8–72]. During the presentation, the author will present his ‘Top Ten List of Transfusion Medicine Randomized Control Trials in Transfusion Medicine’, ranking them in reverse order related to their impact and quality.…”