title: Immune modulation and microchimerism after unmodified versus leukoreduced allogeneic red blood cell transfusion in cancer patients: results of a randomized study.
abstract: 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.
authors.affiliation: 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
authors.forename: Valérie
authors.initials: V
authors.lastname: Lapierre
authors.forename: Anne
authors.initials: A
authors.lastname: Aupérin
authors.forename: Eric
authors.initials: E
authors.lastname: Robinet
authors.forename: Christophe
authors.initials: C
authors.lastname: Ferrand
authors.forename: Nadia
authors.initials: N
authors.lastname: Oubouzar
authors.forename: Dominique
authors.initials: D
authors.lastname: Tramalloni
authors.forename: Philippe
authors.initials: P
authors.lastname: Saas
authors.forename: Bertrand
authors.initials: B
authors.lastname: Debaene
authors.forename: Philippe
authors.initials: P
authors.lastname: Lasser
authors.forename: Pierre
authors.initials: P
authors.lastname: Tiberghien
mesh_terms: 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
chemical_list: D016207:Cytokines; C418974:FOXP3 protein, human; D051858:Forkhead Transcription Factors