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Transfusion of pathogen‐reduced platelet components without leukoreduction
Author(s) -
Sim Joycelyn,
Tsoi Wai Chiu,
Lee Cheuk Kwong,
Leung Rock,
Lam Clarence C. K.,
Koontz Claudia,
Liu Amy Yingjie,
Huang Norman,
Benjamin Richard J,
Vermeij Hans J.,
Stassinopoulos Adonis,
Corash Laurence,
Lie Albert K. W.
Publication year - 2019
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.15269
Subject(s) - medicine , leukoreduction , cohort , hematopoietic stem cell transplantation , incidence (geometry) , platelet , platelet transfusion , cumulative incidence , immunology , gastroenterology , surgery , transplantation , physics , optics
BACKGROUND Leukoreduction (LR) of platelet concentrate (PC) has evolved as the standard to mitigate risks of alloimmunization, clinical refractoriness, acute transfusion reactions (ATRs), and cytomegalovirus infection, but does not prevent transfusion‐associated graft‐versus‐host disease (TA‐GVHD). Amotosalen–ultraviolet A pathogen reduction (A‐PR) of PC reduces risk of transfusion‐transmitted infection and TA‐GVHD. In vitro data indicate that A‐PR effectively inactivates WBCs and infectious pathogens. STUDY DESIGN AND METHODS A sequential cohort study evaluated A‐PR without LR, gamma irradiation, and bacterial screening in hematopoietic stem cell transplant (HSCT) recipients. The first cohort received conventional PC (control) processed without LR, but with gamma irradiation and bacterial screening. The second cohort received A‐PR PC (test) processed without: LR, bacterial screening, or gamma irradiation. The primary efficacy outcome was the 1‐hour corrected count increment. The primary safety outcome was treatment‐emergent ATR. Secondary outcomes included clinical refractoriness, and 100‐day status for engraftment, TA‐GVHD, HSCT‐GVHD, infections, and mortality. RESULTS Mean corrected count increment (× 10 3 ) of 33 test PC recipients was similar (18.9 ± 8.8 vs. 16.6 ± 8.4; p = 0.296) to that of 31 control PC recipients. Test recipients had a reduced, but nonsignificant, incidence of ATR (test = 9.1%, Control = 19.4%; p = 0.296). The frequencies of clinical refractoriness (0 of 33 vs. 4 of 31 patients) and refractory transfusions (6.6% vs. 19.3%) were lower in the test cohort (p = 0.05 and 0.02), respectively. No patient in either cohort had TA‐GVHD. Day 100 engraftment, HSCT‐GVHD, mortality, and infectious disease complications were similar between cohorts. CONCLUSIONS This study indicated that A‐PR PC without LR, gamma irradiation, or bacterial screening is feasible for support of HSCT.