Novel processes for inactivation of leukocytes to prevent transfusion-associated graft-versus-host disease

Abstract

Summary:Transfusion-associated graft-versus-host disease (TA-GVHD) is a serious complication of blood component transfusion therapy. Currently, cellular blood components for patients recognized at risk for TA-GVHD are irradiated prior to transfusion in order to prevent this complication. Considerable progress has been made in elucidating the pathophysiology of this highly morbid complication, but questions as to which patients are at risk and what is the most robust technology to prevent TA-GVHD remain. As new technologies for inactivating or modulating leukocyte function are introduced, the question of how to evaluate these technologies becomes relevant. Over the past two decades, a number of research groups have explored technology to inactivate infectious pathogens and leukocytes contaminating cellular blood components. Few clinicians have an in-depth understanding of the methods or the criteria for selection of how to approach new technologies for leukocyte inactivation with potential to replace current methods. This mini review focuses on the salient aspects of current and evolving technology for prevention of TA-GVHD.

Pathogen inactivation: a new paradigm for blood safety

“…Because the PI process damages DNA and prevents the replication of nucleic acids, the process prevents replication of lymphocytes in treated blood components 13,14 . Thus, PI‐treated blood components should not cause transfusion‐related graft‐versus‐host disease (GVHD).…”

The clinical and biological impact of new pathogen inactivation technologies on platelet concentrates

“…This was one of the major points in the Toronto Consensus Conference recommendation for the implementation of new technologies [9,10]. Two other possible advantages of PI are the inactivation of lymphocytes, obviating the need for γ-irradiation for graft-versus-host disease (GvHD) prophylaxis [11,12], and the extension of shelf life from 5 to 7 days, allowing for better inventory management. However, there are still controversies about the position this type of product holds in the therapeutic arsenal.…”

Prevention of transfusion of platelet components contaminated with low levels of bacteria: a comparison of bacteria culture and pathogen inactivation methods

“…Finally, it should be pointed out that the bacterial testing approach is limited only to the detection of bacteria. The pathogen inactivation of PLT has been shown to be effective in inactivating viruses, 38‐40 protozoa, 41,42 and WBCs, 43 in addition to bacteria, thus providing a more comprehensive approach to transfusion safety.…”