Immunology: Immunotherapy and recurrent abortion: a randomized clinical trial

Abstract

We conducted a randomized trial comparing expectant management versus immunotherapy with paternal leukocytes to improve obstetric outcome in women with unexplained recurrent abortion. Eligible for the study were women with unexplained recurrent abortion (three or more miscarriages and no live birth), negative findings of immunological screening and no inhibition of the mixed lymphocyte culture. These women were seen for the first time between October 1988 and March 1991 in a network of obstetric departments in Northern Italy. Subjects positive for HLA DR3 or with a partner positive for hepatitis virus B antigen were not eligible. A total of 44 women entered the study. Patients were randomly allocated to immunotherapy (22 women) or expectant management (22 women). Women allocated to immunotherapy were given 200 x 10(6) purified paternal lymphocytes before pregnancy. Median follow-up was 24 months (range 10-39) in the immunotherapy group and 25 months (range 11-38) in the expectant management group. Out of the 22 women randomized to immunotherapy, 16 became pregnant and the corresponding value was 14 in the expectant management group. Spontaneous abortion occurred in six out of the 16 pregnancies observed in the treated women. Among the 14 pregnancies observed in the expectant management group, two aborted and one late fetal death occurred. The cumulative proportions of women who became pregnant over 4 years were 37 and 45% in the immunotherapy and expectant management groups respectively; this difference was not significant. No adverse effect was observed in treated women.

Allogenic Lymphocyte Immunotherapy for Unexplained Recurrent Spontaneous Abortion: A Meta‐Analysis

“…Five hundred and ninety‐two studies were initially screened. Eighteen randomized trials published in thirteen English literatures and five Chinese literatures were used for analysis . For the primary outcome measure, live births, we calculated an odds ratio and its 95% confidence intervals.…”

Correlation between serum zinc levels and successful immunotherapy in recurrent spontaneous abortion patients

“…In present study, was observed that different patients have variable responses to this kind of immunotherapy and the cross-match test becomes negative in most cases (154 patients). On the other hand, some studies reported that LIT for unexplained RSA had no beneficial effect,[2728] and, until date, the use of LIT for the treatment of RSA remains a matter of controversy. Lack of response to LIT may be associated with the amount of zinc.…”

“…[23] However, the efficacy of lymphocyte immunotheraphy (LIT) for RSA was doubted by some researchers, because no beneficial effect was found after LIT. [2728] According to previous studies, the effectiveness of LIT in different patients is variable and the cross-match test becomes positive in some cases only. [323] This difference in response to immunotherapy might be associated with various factors such as the amount of trace elements.…”

Inhibitory serum factor of lymphoproliferative response to allogeneic cells in pregnancy

“…IO ,1l,13,14,16,18 In the present study we have assessed the sera of healthy pregnant women and of non-transfused RSA patients, in order to determine whether this factor is essential to the development of a normal pregriancy and to investigate whether its absence could be considered a relevant parameter for the diagnosis and therapeutic orientation of RSA patients.…”

“…10, [14][15][16] We reasoned that if this factor is biologicalIy important for the development of a successful pregnancy, it should regularly be detected in the serum from pregnant women. The present data show that this is not the case, since the inhibitory factor was detected in only 1 out of 13 primigravidae, alI of whom have already delivered a healthy baby.…”