Immune modulation and microchimerism after unmodified versus leukoreduced allogeneic red blood cell transfusion in cancer patients: results of a randomized study.
BACKGROUND
Transfusion of red blood cells (RBCs) has been associated with immunomodulatory effects. Persistence of donor cells in the recipient may be contributive.


METHODS
A randomized single-center trial was conducted to compare microchimerism and immune responses in 35 patients undergoing cancer surgery and transfused perioperatively with either unmodified RBCs (UN-RBCs, n = 18) or leukoreduced RBCs (LR-RBCs, n = 17). Biologic parameters included microchimerism assessment peripheral blood mononuclear cell (PBMNC) phenotyping, cytokine production by stimulated PBMNCs, FoxP3 gene expression, and T-cell repertoire (TCR) analysis.


RESULTS
Microchimerism was documented in 8 of 18 patients after UN-RBC transfusion while absent after LR-RBC transfusion (0/17; p = 0.001). After UN-RBC transfusion, microchimerism was associated with increased interleukin (IL)-10 production (p = 0.02), reduced TCR alteration (p = 0.04), and reduced CD56+ cell counts (p = 0.02) when compared to recipients without evidence for microchimerism. FoxP3 gene expression did not differ significantly between both treatment groups nor with the presence or absence of microchimerism in the UN-RBC group. Finally, after an initial early decrease after surgery and transfusion, IL-12 production increased and more significantly so after UN-RBC transfusion versus LR-RBC transfusion (p = 0.05).


CONCLUSIONS
UN-RBC-induced microchimerism is associated with specific immunomodulatory effects in cancer patients who received transfusions during surgery.
Lapierre
Valérie
V
Unit of Transfusion Medicine and Hemovigilance, the Biostatistics and Epidemiology Service, the Department of Anesthesia and Reanimation, Gustave Roussy Cancer Institute, Villejuif, France. valerie.lapierre@igr.fr
Aupérin
Anne
A
Robinet
Eric
E
Ferrand
Christophe
C
Oubouzar
Nadia
N
Tramalloni
Dominique
D
Saas
Philippe
P
Debaene
Bertrand
B
Lasser
Philippe
P
Tiberghien
Pierre
P
D000328:Adult; D000368:Aged; D001804:Blood Transfusion, Autologous; D046528:Chimerism; D016207:Cytokines / Q000096:biosynthesis; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D004912:Erythrocytes / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D051858:Forkhead Transcription Factors / Q000378:metabolism; D006801:Humans; D007108:Immune Tolerance / Q000276:immunology; D007962:Leukocytes / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000276:immunology* / Q000601:surgery*; D010641:Phenotype; D015996:Survival Rate
D016207:Cytokines; C418974:FOXP3 protein, human; D051858:Forkhead Transcription Factors