Universal prestorage leukoreduction in Canada decreases platelet alloimmunization and refractoriness.
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 products (relative risk [RR], 2.2 [95% CI, 1.2-4.3]), a history of pregnancy and/or transfusion (RR, 2.3 [95% CI, 1.3-4.2]), and receipt of 13 or more platelet transfusions (RR, 6.0 [95% CI, 2.4-15.3]). In conclusion, ULR reduces alloimmunization, refractoriness, and requirements for HLA-matched platelets when applied as routine transfusion practice to patients receiving CT or SCT.
Seftel
Matthew D
MD
Leukemia/Bone Marrow Transplantation (BMT), Division of Hematology, Vancouver General Hospital, Vancouver, BC.
Growe
Gershon H
GH
Petraszko
Tanya
T
Benny
W Barrett
WB
Le
Alan
A
Lee
Chao-Yong
CY
Spinelli
John J
JJ
Sutherland
Heather J
HJ
Tsang
Peter
P
Hogge
Donna E
DE
D000293:Adolescent; D000328:Adult; D000368:Aged; D001781:Blood Component Removal; D001792:Blood Platelets / Q000276:immunology*; D001793:Blood Preservation; D002170:Canada; D002469:Cell Separation; D005260:Female; D006801:Humans; D007114:Immunization; D007518:Isoantibodies / Q000096:biosynthesis; D007938:Leukemia / Q000276:immunology / Q000628:therapy; D007962:Leukocytes / Q000276:immunology; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies
D007518:Isoantibodies