Platelet donor selection for <scp>HLA</scp>‐immunised patients; the impact of donor‐specific <scp>HLA</scp> antibody levels

Linjama, Tiina; Niittyvuopio, Riitta; Tuimala, Jarno; Pyörälä, Marja; Rintala, Hannele; Rimpiläinen, Jussi; Kauppila, Marjut; Peräsaari, Juha; Juvonen, Eeva

doi:10.1111/tme.12412

Cited by 9 publications

(8 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our cohort, an additional 16% of all transfusions were classified as having an “acceptable match” when the impact of DSA was taken into account, giving a total of 31% of the transfusions having no immunologic barrier. These data are in agreement with other blood centers . A potential drawback with this strategy is the risk of new immunizations of already immunized patients, but this concern may be of less importance compared to the immediate needs to minimize risk of bleeding or even to treat ongoing bleeding, in refractory thrombocytopenic patients.…”

Section: Discussionsupporting

confidence: 87%

“…Even centralized larger centers, such as in the United Kingdom, can provide matched platelets for only up to 70% of all patients, despite a registry of 12,000 HLA‐typed blood donors . In a recent study from Finland, approximately 8,000 donors secured suitable platelets to 38% of refractory patients . In relation to these figures, the fraction of HLA‐matched donors identified in our cohort is within the expected range, but the situation is nevertheless worrying.…”

Section: Discussionmentioning

confidence: 58%

“…4 In a recent study from Finland, approximately 8,000 donors secured suitable platelets to 38% of refractory patients. 21 In relation to these figures, the fraction of HLA-matched donors identified in our cohort is within the expected range, but the situation is nevertheless worrying. Increasing the donor pool is thus important, and making an effort to recruit donors of different ethnic groups is particularly important in days of increasing migration.…”

Section: Discussionmentioning

confidence: 61%

“…These data are in agreement with other blood centers. [21][22][23] A potential drawback with this strategy is the risk of new immunizations of already immunized patients, but this concern may be of less importance compared to the immediate needs to minimize risk of bleeding or even to treat ongoing bleeding, in refractory thrombocytopenic patients.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

HLA‐selected platelets for platelet refractory patients with HLA antibodies: a single‐center experience

et al. 2018

View full text Add to dashboard Cite

BACKGROUND Platelet refractoriness due to HLA immunization represents a problem in transfusion management of thrombocytopenic hematology patients. Refractory patients can be managed by HLA‐selected platelet transfusions, but the optimal matching strategy is debated and how the degree of HLA mismatch influences transfusion outcome is poorly studied. STUDY DESIGN AND METHODS We studied 32 hematology patients who received 142 matched platelet units between 2007 and 2016. Four matching strategies were compared: 1) genomic HLA typing at the two digit level, performed using polymerase chain reaction–sequence‐specific oligonucleotide probing; 2) serologic “eplet score” calculated using HLAMatchmaker; 3) cross‐matching using lymphocyte cytotoxicity; and 4) matching based on donor‐specific antibody (DSA) specificity, determined using Luminex. A 1‐hour corrected count increment (CCI) of more than 7.5 × 109/L was considered a successful response. RESULTS Selection of platelets with either a complete HLA match or an acceptable HLA mismatch based on genomic typing and DSA information, each predicted 86% successful transfusion responses. For HLA‐mismatched transfusions, the eplet score correlated with CCI and the fraction of successful transfusions, but less well compared to DSA matching. Cytotoxic crossmatching was least predictive. For transfusions across one to four DSAs, the antibody reaction strength correlated with the 1‐hour CCI, but many transfusions were successful despite the presence of DSA. CONCLUSION A complete HLA‐A and ‐B match or an acceptable mismatch based on DSA should guide identification of donors. Still, transfusions across DSAs are often successful, emphasizing that the presence of DSA is necessary but not sufficient for platelet clearance.

show abstract

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

HLA‐selected platelets for platelet refractory patients with HLA antibodies: a single‐center experience

et al. 2018

View full text Add to dashboard Cite

show abstract

“…A 3‐SD cutoff (i.e., NBG ≥10.8 for HLA Class I or NBG ≥6.9 for HLA Class II) identifies less than 0.5% of never‐transfused males positive for HLA Class I and II . Based on this and other literature, an NBG of 10.8 or higher for HLA Class I and NBG of 6.9 or higher for HLA Class II was considered positive in the main analysis of this study. Panel reactivity (PRA) was determined by counting the number of positive HLA Class I or Class II beads.…”

Section: Methodsmentioning

confidence: 93%

The role of pathogen‐reduced platelet transfusions on HLA alloimmunization in hemato‐oncological patients

et al. 2018

View full text Add to dashboard Cite

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 hematooncological 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. ABBREVIATIONS: IQR = interquartile range; ITT = intention-totreat; NBGs = normalized background ratios; ORs = odds ratios; PCs = platelet concentrates; PP = per-protocol; PRA = panel reactivity; SD = standard deviation; UV = ultraviolet.From the

show abstract

Clinical and immunological features of platelet transfusion refractoriness in young patients with de novo acute myeloid leukemia

Cai

Zheng

et al. 2020

Cancer Medicine

View full text Add to dashboard Cite

Platelet transfusion is important in the prevention and treatment of bleeding in patients with acute myeloid leukemia (AML) after receiving intensive chemotherapy. However, platelet transfusion refractoriness (PTR) is an intractable clinical issue occurred in these patients. And its clinical and immunological features remain largely unknown. The potential causes and clinical features of PTR were retrospectively analyzed in 560 patients who were diagnosed as de novo AML in Tongji Hospital from June 2012 through June 2018. A high‐throughput antibody screening for the detection of human leukocyte antigen (HLA) and its serotypes was performed in 133 newly diagnosed AML patients. PTR occurred in 11.8% of the de novo AML patients. The median age for patients with PTR was 46 years (range, 15‐70). It frequently manifested in female patients and in patients with splenomegaly, M4 subtype, c‐Kit gene mutation, and rearrangements of RUNX1‐RUNX1T1 or CBFB‐MYH11 , commonly referred to as core binding factor AML (CBF‐AML). Notably, CBF‐AML was independently associated with the occurrence of PTR. PTR predominantly developed in patients who had CBF‐AML ( P < .001) and in patients who further had better minimal residual disease (MRD) reduction (≥3‐log) before the second consolidation chemotherapy ( P = .007). HLA‐I antibodies were detected in the serum of 9.0% of AML patients and markedly enriched in patients with PTR ( P < .001) and in patients with CBF‐AML ( P = .018). HLA‐B was the most frequently identified serum epitope in PTR patients. Patients with CBF‐AML had higher tendency to develop HLA‐I antibodies and PTR, which depicted novel features of PTR in AML and might provide insights into its efficient managements.

show abstract

Platelet donor selection for HLA‐immunised patients; the impact of donor‐specific HLA antibody levels

Abstract: The HLAMatchmaker algorithm alone is not a sufficient tool for donor selection. Donor selection based primarily on the levels of donor-specific HLA antibodies is a preferable practice.

Cited by 9 publications

References 36 publications

HLA‐selected platelets for platelet refractory patients with HLA antibodies: a single‐center experience

HLA‐selected platelets for platelet refractory patients with HLA antibodies: a single‐center experience

The role of pathogen‐reduced platelet transfusions on HLA alloimmunization in hemato‐oncological patients

Clinical and immunological features of platelet transfusion refractoriness in young patients with de novo acute myeloid leukemia

Contact Info

Product

Resources

About