Clinical effectiveness of leucoreduced, pooled donor platelet concentrates, stored in plasma or additive solution with and without pathogen reduction.
Pathogen reduction (PR) of platelet products increases costs and available clinical studies are equivocal with respect to clinical and haemostatic effectiveness. We conducted a multicentre, open-label, randomized, non-inferiority trial comparing the clinical effectiveness of buffy-coat derived leukoreduced platelet concentrates (PC) stored for up to 7 d in plasma with platelets stored in platelet additive solution III (PASIII) without and with treatment with amotosalen-HCl/ultraviolet-A (UVA) photochemical pathogen reduction (PR-PASIII). Primary endpoint of the study was 1-h corrected count increment (CCI). Secondary endpoints were 24-h CCI, bleeding, transfusion requirement of red cells and PC, platelet transfusion interval and adverse transfusion reactions. Compared to plasma-PC, in the intention to treat analysis of 278 evaluable patients the mean difference for the 1-h CCI of PR-PASIII-PC and PASIII-PC was -31% (P < 0.0001) and -9% (P = n.s.), respectively. Twenty-seven patients (32%) had bleeding events in the PR-PASIII arm, as compared to 19 (19%) in the plasma arm and 14 (15%) in the PASIII arm (P = 0.034). Despite the potential advantages of pathogen (and leucocyte) inactivation of amotosalen-HCl/UVA-treated platelet products, their clinical efficacy is inferior to platelets stored in plasma, warranting a critical reappraisal of employing this technique for clinical use.
Kerkhoffs
Jean-Louis H
JL
Sanquin Blood Bank, Southwest Region, Rotterdam, The Netherlands. j.kerkhoffs@sanquin.nl
van Putten
Wim L J
WL
Novotny
Viera M J
VM
Te Boekhorst
Peter A W
PA
Schipperus
Martin R
MR
Zwaginga
Jaap Jan
JJ
van Pampus
Lizzy C M
LC
de Greef
Georgine E
GE
Luten
Marleen
M
Huijgens
Peter C
PC
Brand
Anneke
A
van Rhenen
Dick J
DJ
D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000517:prevention & control / Q000635:transmission; D001792:Blood Platelets / Q000382:microbiology*; D001793:Blood Preservation / Q000379:methods*; D005260:Female; D011564:Furocoumarins; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D047589:Leukocyte Reduction Procedures / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010949:Plasma; D017713:Platelet Transfusion / Q000009:adverse effects / Q000379:methods*; D013921:Thrombocytopenia / Q000628:therapy*; D016896:Treatment Outcome; D014466:Ultraviolet Rays; D014777:Virus Diseases / Q000517:prevention & control / Q000635:transmission
D011564:Furocoumarins; C118577:amotosalen