Universal prestorage leukoreduction in Canada decreases platelet alloimmunization and refractoriness

Abstract

Randomized controlled trials have shown a reduction in platelet alloimmunization and refractoriness in patients with acute leukemia (AL) with the use of poststorage leukoreduction of blood products. Universal prestorage leukoreduction (ULR) of red cell and platelet products has been performed in Canada since August 1999. We conducted a retrospective analysis of 13 902 platelet transfusions in 617 patients undergoing chemotherapy (CT) for AL or stem cell transplantation (SCT) before (n ‫؍‬ 315) and after (n ‫؍‬ 302) the introduction of ULR. Alloimmunization was significantly reduced (19% to 7%, P < .001) in the post-ULR group. Alloimmune platelet refractoriness was similarly reduced (14% to 4%, P < .001). Fewer patients in the post-ULR group received HLA-matched platelets (14% vs 5%, P < .001). Alloimmunization and alloimmune refractoriness in the 318 patients who were previously pregnant and/or transfused were also reduced after ULR (P ‫؍‬ .023 and P ‫؍‬ .005, respectively). In a Cox regression model, the 3 independent factors that predicted for alloimmune refractoriness were nonleukoreduced blood

Efficacy of prophylactic transfusions using single donor apheresis platelets versus pooled platelet concentrates in AML/MDS patients receiving allogeneic hematopoietic stem cell transplantation

“…All PPC transfusions were ABO identical, while four (9.8%) had a different ABO type (P ¼ 0.006). Patients received a median of six PPC units (1 U/10 kg of body weight; range, [4][5][6][7][8][9][10][11][12]. Median platelet and hemoglobin levels before transfusion were similar for SDAP and PPC: platelets 14 000/ml (range, 6000-38 000) for SDAP and 15 000/ml for PPC (range, 5000-47 000), and hemoglobin 8.6 g/dl (range, 7.5-11.0) for SDAP versus 8.9 g/dl (range, 7.2-13.2) (P ¼ NS for both comparisons).…”

“…5,6 In the setting of allogeneic hematopoietic stem cell transplantation (HSCT), platelet transfusion refractoriness can be a dramatic situation, 7 given the occurrence of other risk factors for bleeding such as graft-versus-host disease, infections, sepsis, organ dysfunction and disseminated intravascular coagulation. 8 Several strategies have been added to transfusional practice, in an attempt to minimize the problem: leukoreduction, 9 use of ultraviolet irradiated products, 10 dosedependent platelet transfusion trials, 11 use of ABOidentical platelet concentrates, 12 HLA-matched platelet transfusions 13 and use of single-donor apheresis platelets (SDAP) products. The use of SDAP or higher doses of platelets is still controversial and associated with higher costs.…”

Transfusion of minor histocompatibility antigen–mismatched platelets induces rejection of bone marrow transplants in mice

“…Accordingly, PLT products are now routinely stringently leukoreduced prior to transfusion; indeed, removal of leukocytes substantially decreases humoral HLA alloimmunization (17)(18)(19). However, human PLTs also carry serologically defined human PLT antigens (HPAs) (20), which consist of amino acid polymorphisms that may themselves be presented in recipient MHC.…”

Comparison of harvesting methods and clinical application of apheresis platelet concentrates with additive solution

“…К таким осложнениям относят: лихорадочные негемолитические реакции, острое поражение легких, связанное с пере-ливанием, аллоиммунизацию к лейкоцитарным анти-генам, формирование рефрактерности к трансфузиям КТ, болезнь «трансплантат против хозяина» [13][14][15][16][17]. Доказана роль донорских лейкоцитов в развитии по-лиорганной недостаточности у больных, получавших массивные гемотрансфузии [18].…”