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Xhaard A, Floch A, Ruggiu M, Robin M, Sicre de Fontbrune F, Michonneau D, Kaphan E, Prata PHDL, Socié G, Traineau R, Peffault de Latour R, Leprêtre AC. Donor/recipient Rh-mismatched allogeneic hematopoietic stem cell transplantation: transfusion strategy and allo-immunization to red blood cell antigens. Bone Marrow Transplant 2024:10.1038/s41409-024-02316-0. [PMID: 38796632 DOI: 10.1038/s41409-024-02316-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 05/28/2024]
Abstract
In the case of donor/recipient rhesus (Rh)-incompatibility after allogeneic hematopoietic stem cell transplantation (alloHSCT), the transfusion policy in France is to transfuse red blood cells (RBC) in the donor's Rh phenotype from the day of transplantation, leading to a risk of allo-immunization, either of donor or recipient origin. In this single-center retrospective study, the incidence of donor/recipient Rh incompatibility was 7.1% over an 8-year period including 1012 alloHSCT. Six of 58 evaluable patients (10.3%) developed alloantibodies to RBC antigens within one year of alloHSCT. None of these allo-immunizations were directed against the donor-mismatched Rh antigens and none could have been prevented by the transfusion of recipient and donor Rh-compatible RBC units. None of these allo-immunizations led to immune-mediated hemolytic anemia. We observed a statistically significant higher incidence of chronic GVHD among patients with anti-RBC allo-immunization. In the context of donor/recipient Rh incompatibility, the transfusion of packed RBC units in the donor's Rh phenotype from the day of alloHSCT is feasible and not associated with a high risk of allo-immunization. The generalization of this strategy could be discussed even when donor and recipient Rh phenotypes could be respected, to allow the preservation of units of infrequent phenotypes for other indications.
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Affiliation(s)
- Aliénor Xhaard
- Service Hématologie Greffe, Hôpital Saint-Louis, Université Paris Cité, Paris, France.
| | - Aline Floch
- Université Paris Est Créteil, INSERM U955 Equipe Transfusion et Maladies du Globule Rouge, IMRB, Créteil, France
- Laboratoire de Biologie Médicale de Référence en Immunohématologie Moléculaire, Etablissement Français du Sang Ile-de-France, Créteil, France
| | - Mathilde Ruggiu
- Service Hématologie Greffe, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | - Marie Robin
- Service Hématologie Greffe, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | | | - David Michonneau
- Service Hématologie Greffe, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | - Eleonore Kaphan
- Service Hématologie Greffe, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | | | - Gérard Socié
- Service Hématologie Greffe, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | - Richard Traineau
- Etablissement Français du Sang Ile-de-France Site Saint-Louis, Paris, France
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Xhaard A, Bouton M, Delugin L, Giraud C, Guyon A, Giroux-Lathuile C, Hajjout K, Nicolas P, Peyrard T, Ratie V, Boisnard A, Capelle L, Godin S, Traineau R, Yacoub-Agha I, Leprêtre AC. [Transfusion management and immuno-hematological follow-up after allogeneic hematopoietic cell transplantation: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)]. Bull Cancer 2024; 111:S78-S83. [PMID: 37055307 DOI: 10.1016/j.bulcan.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 04/15/2023]
Abstract
The French High Authority of Health (HAS) and National Drug Safety (ANSM) agencies recommendations issued in 2014, the French General Direction of Health (DGS) instruction published in November 2021, the French National Blood Bank (EFS) guidelines and the data available in the literature globally define "good transfusion practices" but provide little information about the immuno-hematological and transfusion management of patients who have received an allogeneic hematopoietic stem transplantation (allo-HCT). The aim of this workshop was to harmonize these practices in situations for which there are currently no recommendations. In order to anticipate possible transfusion issues after allo-HCT, we recommend performing, before the transplantation, an extended red blood cell phenotyping of the donor and a detection of HLA alloimmunization in the recipient. We recommend to systematically perform for minor ABO mismatches: a direct antiglobulin test between D8 and D20, and for major ABO mismatches; a titration of anti-A/anti-B antibodies and an erythrocyte chimerism at D100. At one-year post-transplant, we recommend carrying out an erythrocyte chimerism to allow, if necessary, the update of transfusion counselling (RH phenotype, irradiation of packed red blood cells).
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Affiliation(s)
- Aliénor Xhaard
- AP-HP, hôpital Saint-Louis, service d'hématologie-greffe, 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - Muriel Bouton
- EFS Nouvelle-Aquitaine, site de Pessac Haut-Lévêque, avenue de Magellan, Pessac, France
| | - Laurence Delugin
- EFS Bretagne, laboratoire immuno-hématologie érythrocytaire, rue Pierre-Jean-Gineste, 35011 Rennes cedex, France
| | - Christine Giraud
- CHU de Poitiers, service d'hématologie et de thérapie cellulaire, 2, rue de la Miletrie, 86021 Poitiers, France; Centre de soins, EFS NVAQ, site de Poitiers, laboratoire de thérapie cellulaire, 350, avenue Jacques-Cœur, BP 482, 86012 Poitiers cedex, France
| | - Alizée Guyon
- EFS Bourgogne-Franche-Comté, 8, rue du Docteur Jean-François-Xavier-Girod, 25000 Besançon, France
| | | | - Khadija Hajjout
- Centre régional de transfusion sanguine de Rabat, Rabat, Maroc
| | - Pascal Nicolas
- EFS Grand-Est, 10, rue Spielmann, 67000 Strasbourg, France
| | | | - Vanessa Ratie
- EFS Bourgogne-Franche-Comté, 8, rue du Docteur Jean-François-Xavier-Girod, 25000 Besançon, France
| | - Anne Boisnard
- AP-HP, hôpital Necker, service d'hématologie adulte, 151, rue de Sèvres, 75015 Paris, France
| | - Lucie Capelle
- CHU de Lille, service hématologie pédiatrique, Lille, France
| | - Sandrine Godin
- CHU de Lille, service hématologie pédiatrique, Lille, France
| | | | - Ibrahim Yacoub-Agha
- Université de Lille, CHU de Lille, Infinite, Inserm U1286, 59000 Lille, France
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Yakoub-Agha I, Greco R, Onida F, de la Cámara R, Ciceri F, Corbacioglu S, Dolstra H, Glass B, Kenyon M, McLornan DP, Neven B, de Latour RP, Peric Z, Ruggeri A, Snowden JA, Sureda A, Sánchez-Ortega I. Practice harmonization workshops of EBMT: an expert-based approach to generate practical and contemporary guidelines within the arena of hematopoietic cell transplantation and cellular therapy. Bone Marrow Transplant 2023:10.1038/s41409-023-01958-w. [PMID: 36973515 DOI: 10.1038/s41409-023-01958-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 02/21/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023]
Abstract
AbstractFor hematopoietic cell transplantation (HCT) and cellular therapy (CT), clinical patient care is localized, and practices may differ between countries and from center to center even within the same country. Historically, international guidelines were not always adapted to the changing daily clinical practice and practical topics there were not always addressed. In the absence of well-established guidelines, centers tended to develop local procedures/policies, frequently with limited communication with other centers. To try to harmonize localized clinical practices for malignant and non-malignant hematological disorders within EBMT scope, the practice harmonization and guidelines (PH&G) committee of the EBMT will co-ordinate workshops with topic-specific experts from interested centers. Each workshop will discuss a specific issue and write guidelines/recommendations that practically addresses the topic under review. To provide clear, practical and user-friendly guidelines when international consensus is lacking, the EBMT PH&G committee plans to develop European guidelines by HCT and CT physicians for peers’ use. Here, we define how workshops will be conducted and guidelines/recommendations produced, approved and published. Ultimately, there is an aspiration for some topics, where there is sufficient evidence base to be considered for systematic reviews, which are a more robust and future-proofed basis for guidelines/recommendations than consensus opinion.
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Goel R, Nellis ME, Karam O, Hanson SJ, Tormey CA, Patel RM, Birch R, Sachais BS, Sola-Visner MC, Hauser RG, Luban NLC, Gottschall J, Josephson CD, Hendrickson JE, Karafin MS. Transfusion practices for pediatric oncology and hematopoietic stem cell transplantation patients: Data from the National Heart Lung and Blood Institute Recipient Epidemiology and Donor Evaluation Study-III (REDS-III). Transfusion 2021; 61:2589-2600. [PMID: 34455598 DOI: 10.1111/trf.16626] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/26/2021] [Accepted: 06/27/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND To evaluate transfusion practices in pediatric oncology and hematopoietic stem cell transplant (HSCT) patients. STUDY DESIGN AND METHODS This is a multicenter retrospective study of children with oncologic diagnoses treated from 2013 to 2016 at hospitals participating in the National Heart Lung and Blood Institute Recipient Epidemiology and Donor Evaluation Study-III. Transfusion practices were evaluated by diagnosis codes and pre-transfusion laboratory values. RESULTS A total of 4766 inpatient encounters of oncology and HSCT patients were evaluated, with 39.3% (95% confidence interval [CI]: 37.9%-40.7%) involving a transfusion. Red blood cells (RBCs) were the most commonly transfused component (32.4%; 95% CI: 31.1%-33.8%), followed by platelets (22.7%; 95% CI: 21.5%-23.9%). Patients in the 1 to <6 years of range were most likely to be transfused and HSCT, acute myeloid leukemia, and aplastic anemia were the diagnoses most often associated with transfusion. The median hemoglobin (Hb) prior to RBC transfusion was 7.5 g/dl (10-90th percentile: 6.4-8.8 g/dl), with 45.7% of transfusions being given at 7 to <8 g/dl. The median platelet count prior to platelet transfusion was 20 × 109 /L (10-90th percentile: 8-51 × 109 /L), and 37.9% of transfusions were given at platelet count of >20-50 × 109 /L. The median international normalized ratio (INR) prior to plasma transfusion was 1.7 (10-90th percentile: 1.3-2.7), and 36.3% of plasma transfusions were given at an INR between 1.4 and 1.7. DISCUSSION Transfusion of blood components is common in hospitalized pediatric oncology/HSCT patients. Relatively high pre-transfusion Hb and platelet values and relatively low INR values prior to transfusion across the studied diagnoses highlight the need for additional studies in this population.
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Affiliation(s)
- Ruchika Goel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Departments of Internal Medicine and Pediatrics, Division of Hematology Oncology, Simmons Cancer Institute at SIU School of Medicine and ImpactLife (Mississippi Valley Regional Blood Center), Springfield, Illinois, USA
| | - Marianne E Nellis
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA
| | - Oliver Karam
- Department of Pediatrics, Division of Critical Care, Children's Hospital of Richmond at VCU, Richmond, Virginia, USA
| | - Sheila J Hanson
- Department of Pediatrics, Division of Critical Care, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Ravi M Patel
- Department of Pediatrics, Division of Neonatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rebecca Birch
- Public Health and Epidemiology Practice, Westat, Rockville, Maryland, USA
| | | | - Martha C Sola-Visner
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ronald G Hauser
- Department of Laboratory Medicine, Yale University, New Haven, Connecticut, USA.,Department of Pathology & Laboratory Medicine Service, Veterans Affairs, Connecticut Healthcare System, West Haven, CT
| | - Naomi L C Luban
- Children's Research Institute, Children's National Health System, Washington, District of Columbia, USA
| | | | - Cassandra D Josephson
- Department of Pediatrics, Division of Neonatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jeanne E Hendrickson
- Department of Laboratory Medicine, Yale University, New Haven, Connecticut, USA.,Department of Pediatrics, Yale University, New Haven, CT
| | - Matthew S Karafin
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Solves P, Lozano M, Zhiburt E, Anguita Velasco J, Maria Pérez-Corral A, Monsalvo-Saornil S, Yamazaki S, Okazaki H, Selleng K, Aurich K, Krüger W, Buser A, Holbro A, Infanti L, Stehle G, Pierelli L, Matteocci A, Rigacci L, De Vooght KMK, Kuball JHE, Fielding KL, Westerman DA, Wood EM, Cohn CS, Johnson A, Koh MBC, Qadir D, Cserti-Gazdewich C, Daguindau E, Angelot-Delettre F, Tiberghien P, Wendel-Neto S, Fachini RM, Morton S, Craddock C, Lumley M, Antoniewicz-Papis J, Hałaburda K, Łętowska M, Dunbar N. International Forum on Transfusion Practices in Haematopoietic Stem-Cell Transplantation: Responses. Vox Sang 2021; 116:e25-e43. [PMID: 33866580 DOI: 10.1111/vox.13021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/01/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Pilar Solves
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Eugene Zhiburt
- Pirogov National Medical Surgical Center, Moscow, Russia
| | | | | | | | | | | | - Kathleen Selleng
- Institut für Immunologie und Transfusionsmedizin, Greifswald, Germany
| | - Konstanze Aurich
- Institut für Immunologie und Transfusionsmedizin, Greifswald, Germany
| | - William Krüger
- Klinik für Hämatologie und Onkologie, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Andreas Buser
- Regional Blood Transfusion Service, Swiss Red Cross, Basel, Switzerland
| | - Andreas Holbro
- Regional Blood Transfusion Service, Swiss Red Cross, Basel, Switzerland
| | - Laura Infanti
- Regional Blood Transfusion Service, Swiss Red Cross, Basel, Switzerland
| | - Gregor Stehle
- Regional Blood Transfusion Service, Swiss Red Cross, Basel, Switzerland
| | - Luca Pierelli
- Sapienza University, Rome, Italy.,San Camillo Forlanini Hospital, Rome, Italy
| | | | | | | | | | - Katherine L Fielding
- Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, Vic, Australia
| | | | - Erica M Wood
- Peter MacCallum Cancer Centre, Parkville, Vic, Australia
| | | | | | | | - Dara Qadir
- St George's University Hospital, London, UK
| | | | | | | | | | | | | | | | - Charles Craddock
- University Hospitals Birmingham NHS Foundation Trust, Sutton Coldfield, UK
| | - Matthew Lumley
- University Hospitals Birmingham NHS Foundation Trust, Sutton Coldfield, UK
| | | | | | | | - Nancy Dunbar
- Dartmouth-Hitchcock Medical Center - Pathology, Lebanon, NH, USA
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