Leukocyte reduction and ultraviolet B irradiation of platelets to prevent alloimmunization and refractoriness to platelet transfusions.
Leukocyte reduction and ultraviolet B irradiation of platelets to prevent alloimmunization and refractoriness to platelet transfusions.
复制标题
血小板减少白细胞和紫外线 B 照射，以防止同种免疫和血小板输注无效。
DOI：
10.1056/nejm199712253372601
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发表时间：
1997
期刊：
影响因子：
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通讯作者：
TrialtoReduceAlloimmunizationtoPlateletsStudyGroup
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文献类型：
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作者：
TrialtoReduceAlloimmunizationtoPlateletsStudyGroup
背景我们进行了一项多机构，随机，一项双盲试验，旨在确定使用经过滤器去除白细胞或经紫外线B照射处理的血小板是否能预防抗血小板同种抗体的形成和血小板输注的难治性。输血：来自随机供体的未修饰的合并的血小板浓缩物（对照）;来自随机供体的过滤的合并的血小板浓缩物（F-PC）;来自随机供体的紫外线B照射的合并的血小板浓缩物（UVB-PC）;或通过单采血液成分术从单个随机供体获得的过滤的血小板（F-AP）。结果在530例基线无同种抗体的患者中，对照组有13%的患者产生了淋巴细胞毒性抗体，血小板减少成为血小板输注难治性，而F-PC组为3%，UVB-PC组为5%，F-AP组为4%（各治疗组与对照组比较P<0.03，治疗组间无显著性差异）。在45%的对照组中发现了淋巴细胞毒性抗体，而在治疗组中为17%至21%（每个治疗组与对照组相比P<0.001;治疗组之间没有显著差异）。抗血小板糖蛋白的抗体在6至11%的患者中发展，与四个groups.ConclusionsReduction的白细胞过滤和紫外线B照射的血小板是同样有效的，在预防同种抗体介导的难治性血小板化疗期间急性髓系白血病。与来自随机供体的合并血小板浓缩物相比，通过单采随机供体获得的血小板没有提供额外的益处。
BackgroundWe conducted a multi-institutional, randomized, blinded trial to determine whether the use of platelets from which leukocytes had been removed by a filter or that had been treated with ultraviolet B irradiation would prevent the formation of antiplatelet alloantibodies and refractoriness to platelet transfusions.MethodsPatients who were receiving induction chemotherapy for acute myeloid leukemia were randomly assigned to receive one of four types of platelet transfusions: unmodified, pooled platelet concentrates from random donors (control); filtered, pooled platelet concentrates from random donors (F-PC); ultraviolet B–irradiated, pooled platelet concentrates from random donors (UVB-PC); or filtered platelets obtained by apheresis from single random donors (F-AP). All patients received transfusions of filtered, leukocyte-reduced red cells.ResultsOf 530 patients with no alloantibodies at base line, 13 percent of those in the control group produced lymphocytotoxic antibodies and their thrombocytopenia became refractory to platelet transfusions, as compared with 3 percent in the F-PC group, 5 percent in the UVB-PC group, and 4 percent in the F-AP group (P<0.03 for each treated group as compared with the controls; there were no significant differences among the treated groups). Lymphocytotoxic antibodies were found in 45 percent of the controls, as compared with 17 to 21 percent in the treated groups (P<0.001 for each treated group as compared with the controls; there were no significant differences among the treated groups). Antibodies against platelet glycoproteins developed in 6 to 11 percent of the patients, with no significant differences among the four groups.ConclusionsReduction of leukocytes by filtration and ultraviolet B irradiation of platelets are equally effective in preventing alloantibody-mediated refractoriness to platelets during chemotherapy for acute myeloid leukemia. Platelets obtained by apheresis from single random donors provided no additional benefit as compared with pooled platelet concentrates from random donors.