Transfusion‐associated graft‐versus‐host disease: report of an occurrence following the administration of irradiated blood

Abstract

Patients who are heavily immunosuppressed, such as those undergoing intensive anti-cancer chemotherapy, are at risk for development of accidental engraftment and graft-versus-host disease when they undergo transfusion with cellular blood components, a condition known as transfusion-associated graft-versus-host disease (TA-GVHD). To prevent this complication, it is routine to irradiate such blood components prior to their transfusion, although the minimum irradiation dose required is uncertain. The development of probable TA-GVHD is reported in a 10-year-old child following transfusions of platelets and packed red cells that had been irradiated at a nominal dose of 15 Gy. The transfusions were given during treatment for relapse of acute myeloid leukemia. Although the child developed complications including exfoliative dermatitis, delayed bone marrow regeneration, renal failure requiring dialysis, and respiratory failure requiring assisted respiration, she recovered from the episode of TA-GVHD after treatment with high-dose methylprednisolone and antithymocyte globulin. However, her leukemia relapsed, and she died. This experience suggests that the irradiation of cellular blood components at a nominal dose of 15 Gy prior to their transfusion to heavily immunosuppressed patients may be insufficient to prevent TA-GVHD.

Protection against Transfusion-Associated Graft-versus-Host Disease in Blood Transfusion: Is Gamma-Irradiation the Only Answer?

“…These in vitro results are in line with the clinical observation that TAGvHD can occur when transfusing blood components irradiated with a dose of less than 25 Gy as the minimum [51]. In addition, the loss of T-cell replication competence using PCR amplification of genomic DNA sequences, the inhibition of cytokine synthesis by contaminating leukocytes, and the surface expression of proliferation-associated T-cell activation markers, such as CD25 and CD69, has been studied in more detail [50,52].…”

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

“…Supporting this observation, TA-GVHD has been reported in transfusion recipients who received blood components irradiated with 1500 cGy. 15 Similar studies have been conducted with the nucleic acid targeted compound S-303 developed to inactivate infectious pathogens and leukocytes in red cell concentrates. 57 This technology utilizes a class of compounds known as frangible anchor linker effectors (FRALES) that intercalate into nucleic acid and form covalent crosslinks without activation by UVA light.…”

“…12 These observations suggest that the safety margins for irradiation are narrow. [13][14][15] Thus, while considerable progress has been made in understanding this highly morbid complication of transfusion therapy, questions as to which patients are at risk and what is the most robust technology to prevent TA-GVHD remain. In addition, as new technologies for inactivating or modulating leukocyte function are introduced, the question of how to evaluate these technologies becomes relevant.…”

Graft Versus Host Disease in Intestinal Transplantation

“…Graft vs. host disease is an expected complication of bone marrow transplantation, but has also been reported after transfusion of irradiated and nonirradiated blood products, in patients with immunodeficiency syndromes, and patients receiving chemotherapy (16)(17)(18)(19), and recipients of solid-organ transplants (4)(5)(6)(7)(8). Though recipients of small bowel transplants are theoretically at high risk owing to the amount of lymphoid containing tissue in the graft (20), the incidence and management of this complication in small bowel transplantation in humans has not been well described.…”