IMMUNOABSORPTION THERAPY FOR PLATELET ALLOIMMUNIZATION

HLA抗原的同种异体免疫和由此产生的对随机 接受治疗的患者中有30 - 90%进行血小板输注 治疗急性白血病和再生障碍性贫血同种免疫的管理 病人是困难的，主要是在提供HLA匹配 血小板成分。 然而，在某些情况下，即使输血与“HLA- 匹配的”血小板不会有效地提高血小板计数， 患者面临自发性出血的重大风险。 最近的报告 自身免疫性疾病患者血小板自身抗体成功清除 葡萄球菌蛋白A柱吸附法诊断血小板减少性紫癜 建议，这一程序可能有利于消除 血小板输注难治性患者的血小板同种抗体。 本研究旨在确定葡萄球菌蛋白A吸收 是血小板同种异体免疫的有效疗法。 十五名患者 由于HLA或血小板特异性 同种抗体将经历四次葡萄球菌蛋白A单采治疗， 两周的时间。 对随机供体和HLA匹配血小板的反应 将评估HLA抗体的浓缩物和反应性模式 在蛋白A治疗前后。 到目前为止，只有一名患者 完成了协议。 该患者对以下药物的反应没有改善 蛋白A吸收后可见血小板输注。 无不良 治疗的效果。 这项研究继续积累 患者

Alloimmunization to HLA antigens and resultant refractoriness to random platelet transfusions occurs in 30 to 90% of patients undergoing treatment for acute leukemia and aplastic anemia. Management of the alloimmunized patient is difficult and consists mainly in provision of HLA-matched platelet components. In some cases, however, even transfusion with "HLA- matched" platelets will not effectively raise the platelet count, placing the patient at major risk of spontaneous bleeding. Recent reports of the successful removal of platelet autoantibody in patients with autoimmune thrombocytopenic purpura by staphylococcal protein A column absorption suggested that this procedure might be of benefit in the removal of platelet alloantibody in patients refractory to platelet transfusions. This study was designed to determine if staphylococcal protein A absorption is an effective therapy for platelet alloimmunization. Fifteen patients refractory to platelet transfusions due to HLA or platelet specific alloantibodies will undergo four staph protein A apheresis treatments over a two week period. Response to random-donor and HLA-matched platelet concentrates and pattern of reactivity of HLA antibodies will be assessed before and after protein A treatments. To date, only one patient has completed the protocol. No improvement in this patient's response to platelet transfusions was seen after protein A absorption. No adverse effects of therapy were encountered. This study continues to accrue patients.