1
|
Westhoff CM, Floch A. Blood group genotype matching for transfusion. Br J Haematol 2024. [PMID: 39104129 DOI: 10.1111/bjh.19664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 07/11/2024] [Indexed: 08/07/2024]
Abstract
The last decade has seen significant growth in the application of DNA-based methods for extended antigen typing, and the use of gene sequencing to consider variation in blood group genes to guide clinical care. The challenge for the field now lies in educating professionals, expanding accessibility and standardizing the use of genotyping for routine patient care. Here we discuss applications of genotyping when transfusion is not straightforward including when compatibility cannot be demonstrated by routine methods, when Rh type is unclear, when allo- and auto-antibodies are encountered in stem cell and organ transplantation, for prenatal testing to determine maternal and foetal risk for complications, and Group A subtyping for kidney and platelet donors. We summarize current commercial testing resources and new approaches to testing including high-density arrays and targeted next-generation sequencing (NGS).
Collapse
Affiliation(s)
- Connie M Westhoff
- New York Blood Center Enterprises, National Center for Blood Group Genomics, New York, New York, USA
| | - Aline Floch
- Univ Paris Est Creteil, INSERM U955 Equipe Transfusion et Maladies du Globule Rouge, IMRB, Creteil, France
- Laboratoire de Biologie Medicale de Référence en Immuno-Hematologie Moleculaire, Etablissement Francais du Sang Ile-de-France, Creteil, France
| |
Collapse
|
2
|
Carrillo de Albornoz S, Chai KL, Higgins AM, Petrie D, Wood EM, McQuilten ZK. A systematic review of the cost and cost-effectiveness of immunoglobulin treatment in patients with hematological malignancies. Int J Technol Assess Health Care 2024; 40:e32. [PMID: 38751245 DOI: 10.1017/s026646232400028x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2024]
Abstract
OBJECTIVES Patients with hematological malignancies are likely to develop hypogammaglobulinemia. Immunoglobulin (Ig) is commonly given to prevent infections, but its overall costs and cost-effectiveness are unknown. METHODS A systematic review was conducted following the PRISMA guidelines to assess the evidence on the costs and cost-effectiveness of Ig, administered intravenously (IVIg) or subcutaneously (SCIg), in adults with hematological malignancies. RESULTS Six studies met the inclusion criteria, and only two economic evaluations were identified; one cost-utility analysis (CUA) of IVIg versus no Ig, and another comparing IVIg with SCIg. The quality of the evidence was low. Compared to no treatment, Ig reduced hospitalization rates. One study reported no significant change in hospitalizations following a program to reduce IVIg use, and an observational study comparing IVIg with SCIg suggested that there were more hospitalizations with SCIg but lower overall costs per patient. The CUA comparing IVIg versus no Ig suggested that IVIg treatment was not cost-effective, and the other CUA comparing IVIg to SCIg found that home-based SCIg was more cost-effective than IVIg, but both studies had serious limitations. CONCLUSIONS Our review highlighted key gaps in the literature: the cost-effectiveness of Ig in patients with hematological malignancies is very uncertain. Despite increasing Ig use worldwide, there are limited data regarding the total direct and indirect costs of treatment, and the optimal use of Ig and downstream implications for healthcare resource use and costs remain unclear. Given the paucity of evidence on the costs and cost-effectiveness of Ig treatment in this population, further health economic research is warranted.
Collapse
Affiliation(s)
| | - Khai Li Chai
- School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Alisa M Higgins
- School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Dennis Petrie
- Centre for Health Economics, Monash Business School, Monash University, Clayton, VIC, Australia
| | - Erica M Wood
- School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Zoe K McQuilten
- School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| |
Collapse
|
3
|
Peero EK, Banjar S, Khoudja R, Ton-Leclerc S, Beauchamp C, Benoit J, Beltempo M, Dahan MH, Gold P, Kadoch IJ, Jamal W, Laskin C, Mahutte N, Phillips S, Sylvestre C, Reinblatt S, Mazer BD, Buckett W, Genest G. Intravenous immunoglobulin for patients with unexplained recurrent implantation failure: a 6-year single center retrospective review of clinical outcomes. Sci Rep 2024; 14:3876. [PMID: 38365988 PMCID: PMC10873418 DOI: 10.1038/s41598-024-54423-z] [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: 11/14/2023] [Accepted: 02/13/2024] [Indexed: 02/18/2024] Open
Abstract
The effectiveness of intravenous immunoglobulin (IVIg) for patients with unexplained recurrent implantation failure (uRIF) remains debated. We retrospectively analysed outcomes of uRIF patients treated with IVIg compared to a separate control uRIF cohort within our center (01/2014-12/2021). Primary outcomes included live birth, miscarriage, or transfer failure. We documented IVIg side effects and maternal/fetal outcomes. Logistic regression analysis was used to assess for association of IVIg exposure with outcomes and adjust for confounders. The study included 143 patients, with a 2:1 ratio of controls to patients receiving IVIg treatment. Patient characteristics were similar between groups. There was higher live birth rate (LBR) in patients receiving IVIg (32/49; 65.3%) compared to controls (32/94; 34%); p < 0.001). When stratifying patients into moderate and severe uRIF (respectively 3-4 and [Formula: see text] 5 previous good quality blastocyst transfer failures), only patients with severe uRIF benefited from IVIg (LBR (20/29 (69%) versus 5/25 (20%) for controls, p = 0.0004). In the logistic regression analysis, IVIg was associated with higher odds of live birth (OR 3.64; 95% CI 1.78-7.67; p = 0.0004). There were no serious adverse events with IVIg. IVIg can be considered in well selected patients with [Formula: see text] 5 previous unexplained, high quality blastocyst transfer failures. A randomized controlled trial is needed to confirm these findings.
Collapse
Affiliation(s)
- Einav Kadour Peero
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Bnai-Zion Medical Center, Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Shorooq Banjar
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rabea Khoudja
- Division of Clinical Immunology and Allergy, Department of Medicine, McGill University Health Centre, Montréal, QC, Canada
| | | | - Coralie Beauchamp
- Ovo Clinic, 8000 Boulevard Decarie, Montréal, QC, H4P 2S4, Canada
- Obstetrics and Gynaecology Department, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada
| | - Joanne Benoit
- Ovo Clinic, 8000 Boulevard Decarie, Montréal, QC, H4P 2S4, Canada
- Obstetrics and Gynaecology Department, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada
| | - Marc Beltempo
- Division of Neonatology, Montreal Children's Hospital - McGill University Health Centre, Montreal, QC, Canada
| | - Michael H Dahan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, McGill University, McGill University Health Centre, Montréal, QC, Canada
| | - Phil Gold
- Department of Allergy and Immunology, Montreal General Hospital, 1650 Cedar Ave. A6-123, Montreal, QC, H3G 1A4, Canada
| | - Isaac Jacques Kadoch
- Ovo Clinic, 8000 Boulevard Decarie, Montréal, QC, H4P 2S4, Canada
- Obstetrics and Gynaecology Department, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada
| | - Wael Jamal
- Clinique OVO, 8000 boulevard Décarie, Montréal, QC, H4P 2S4, Canada
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Carl Laskin
- TRIO Fertility, 655 Bay St, Toronto, ON, M5G 2K4, Canada
- Deptartments of Medicine and Obstetrics & Gynecology University of Toronto, 27 King's College Cir, Toronto, ON, M5S, Canada
| | - Neal Mahutte
- The Montreal Fertility Centre, 5252 de Maisonneuve Blvd West, Suite 220, Montreal, QC, H4A 3S5, Canada
| | - Simon Phillips
- Clinique OVO, 8000 boulevard Décarie, Montréal, QC, H4P 2S4, Canada
- Faculty of Medicine, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada
| | - Camille Sylvestre
- Ovo Clinic, 8000 Boulevard Decarie, Montréal, QC, H4P 2S4, Canada
- Division of Reproductive Endocrinology and Infertility, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T1J4, Canada
| | - Shauna Reinblatt
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, McGill University, McGill University Health Centre, Montréal, QC, Canada
- McGill University Health Care Reproductive Center, 888 Boul. De Maisonneuve E# 200, Montreal, QC, H2L 4S8, Canada
| | - Bruce D Mazer
- Department of Pediatrics, Division of Allergy Immunology and Clinical Dermatology, Montreal Children's Hospital, McGill University, Montréal, QC, Canada
- Program in Translational Research in Respiratory Diseases, Research Institute of the McGill, University Health Centre, Montréal, QC, Canada
| | - William Buckett
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, McGill University, McGill University Health Centre, Montréal, QC, Canada
- McGill University Health Care Reproductive Center, 888 Boul. De Maisonneuve E# 200, Montreal, QC, H2L 4S8, Canada
| | - Genevieve Genest
- Division of Clinical Immunology and Allergy, Department of Medicine, McGill University Health Centre, Montréal, QC, Canada.
| |
Collapse
|
4
|
De Silvestro G, Catalano L, Marano G, Piccinini V, Pupella S, Ostuni A, De Angelis V. The Italian registry of therapeutic apheresis in SISTRA: Year of activity 2022. Transfus Apher Sci 2024; 63:103863. [PMID: 38065773 DOI: 10.1016/j.transci.2023.103863] [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: 09/28/2023] [Revised: 12/01/2023] [Accepted: 12/02/2023] [Indexed: 03/10/2024]
Abstract
Therapeutic apheresis refers to a group of extracorporeal blood processing procedures used in the treatment of a variety of systemic diseases. These complex procedures are burdened by adverse reactions related to both procedures and underlying medical conditions. Given the importance of centralizing the collection and the analysis of information on therapeutic apheresis, the Italian National Blood Center (NBC), at the request of the Italian Scientific Society of Hemapheresis and Cell Manipulation (SIdEM), implemented the Italian Registry of Therapeutic Apheresis (IRTA) including it in the Information System of Transfusion Services (SISTRA), coordinated by the NBC. In 2022, a total of 34,702 therapeutic apheresis procedures was carried out in 8,781 patients, including paediatric patients, with an average of 3.9 procedures per patient. The 2022 IRTA data indicate that the patient with hematological and/or neurological disorders mainly turns to the apheresis centers. These results confirm the IRTA data from years 2020 and 2021. In the hematological field, the apheresis centers supply hematopoietic stem cells collection for autologous transplantation as well as mononuclear cell collection for extracorporeal photopheresis. With regard to the neurological field, myasthenia, chronic inflammatory demyelinating polyneuropathy and Guillain-Barré syndrome along with other neurological pathologies related to immune disorders are the most treated. In conclusion, this manuscript presents 2022 activity data of IRTA providing institutions and scientific societies with a wide range of information including type and number of therapeutic procedures, adverse events and patients' outcome.
Collapse
Affiliation(s)
- Giustina De Silvestro
- Italian Scientific Society of Haemapheresis and Cell Manipulation SIdEM, Pescara Italy
| | - Liviana Catalano
- Italian National Blood Center, National Institute of Health, Rome Italy.
| | - Giuseppe Marano
- Center of Reference for Gender Medicine, National Institute of Health, Rome, Italy
| | - Vanessa Piccinini
- Italian National Blood Center, National Institute of Health, Rome Italy
| | - Simonetta Pupella
- Italian National Blood Center, National Institute of Health, Rome Italy
| | - Angelo Ostuni
- Italian Scientific Society of Haemapheresis and Cell Manipulation SIdEM, Pescara Italy
| | | |
Collapse
|
5
|
van de Munckhof A, Borhani-Haghighi A, Aaron S, Krzywicka K, van Kammen MS, Cordonnier C, Kleinig TJ, Field TS, Poli S, Lemmens R, Scutelnic A, Lindgren E, Duan J, Arslan Y, van Gorp ECM, Kremer Hovinga JA, Günther A, Jood K, Tatlisumak T, Putaala J, Heldner MR, Arnold M, de Sousa DA, Wasay M, Arauz A, Conforto AB, Ferro JM, Coutinho JM. Cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia in middle-income countries. Int J Stroke 2023; 18:1112-1120. [PMID: 37277922 PMCID: PMC10614174 DOI: 10.1177/17474930231182901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/26/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Adenovirus-based COVID-19 vaccines are extensively used in low- and middle-income countries (LMICs). Remarkably, cases of cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) have rarely been reported from LMICs. AIMS We studied the frequency, manifestations, treatment, and outcomes of CVST-VITT in LMICs. METHODS We report data from an international registry on CVST after COVID-19 vaccination. VITT was classified according to the Pavord criteria. We compared CVST-VITT cases from LMICs to cases from high-income countries (HICs). RESULTS Until August 2022, 228 CVST cases were reported, of which 63 were from LMICs (all middle-income countries [MICs]: Brazil, China, India, Iran, Mexico, Pakistan, Turkey). Of these 63, 32 (51%) met the VITT criteria, compared to 103 of 165 (62%) from HICs. Only 5 of the 32 (16%) CVST-VITT cases from MICs had definite VITT, mostly because anti-platelet factor 4 antibodies were often not tested. The median age was 26 (interquartile range [IQR] 20-37) versus 47 (IQR 32-58) years, and the proportion of women was 25 of 32 (78%) versus 77 of 103 (75%) in MICs versus HICs, respectively. Patients from MICs were diagnosed later than patients from HICs (1/32 [3%] vs. 65/103 [63%] diagnosed before May 2021). Clinical manifestations, including intracranial hemorrhage, were largely similar as was intravenous immunoglobulin use. In-hospital mortality was lower in MICs (7/31 [23%, 95% confidence interval (CI) 11-40]) than in HICs (44/102 [43%, 95% CI 34-53], p = 0.039). CONCLUSIONS The number of CVST-VITT cases reported from LMICs was small despite the widespread use of adenoviral vaccines. Clinical manifestations and treatment of CVST-VITT cases were largely similar in MICs and HICs, while mortality was lower in patients from MICs.
Collapse
Affiliation(s)
- Anita van de Munckhof
- Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Katarzyna Krzywicka
- Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | - Mayte Sánchez van Kammen
- Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172—LilNCog—Lille Neuroscience & Cognition, Lille, France
| | | | | | - Sven Poli
- University Hospital Tuebingen, Eberhard-Karls University, Tuebingen, Germany
| | | | - Adrian Scutelnic
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Erik Lindgren
- Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jiangang Duan
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yıldız Arslan
- Medicana İzmir International Hospital, Izmir, Turkey
| | | | | | | | - Katarina Jood
- Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Turgut Tatlisumak
- Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jukka Putaala
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mirjam R Heldner
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Antonio Arauz
- National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | - José M Ferro
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Jonathan M Coutinho
- Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
6
|
Santoro JD, Spinazzi NA, Filipink RA, Hayati-Rezvan P, Kammeyer R, Patel L, Sannar EA, Dwyer L, Banerjee AK, Khoshnood M, Jafarpour S, Boyd NK, Partridge R, Gombolay GY, Christy AL, Real de Asua D, Del Carmen Ortega M, Manning MA, Van Mater H, Worley G, Franklin C, Stanley MA, Brown R, Capone GT, Quinn EA, Rafii MS. Immunotherapy responsiveness and risk of relapse in Down syndrome regression disorder. Transl Psychiatry 2023; 13:276. [PMID: 37553347 PMCID: PMC10409776 DOI: 10.1038/s41398-023-02579-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/10/2023] Open
Abstract
Down syndrome regression disorder (DSRD) is a clinical symptom cluster consisting of neuropsychiatric regression without an identifiable cause. This study evaluated the clinical effectiveness of IVIg and evaluated clinical characteristics associated with relapse after therapy discontinuation. A prospective, multi-center, non-randomized, observational study was performed. Patients met criteria for DSRD and were treated with IVIg. All patients underwent a standardized wean-off therapy after 9-12 months of treatment. Baseline, on-therapy, and relapse scores of the Neuropsychiatric Inventory Total Score (NPITS), Clinical Global Impression-Severity (CGI-S), and the Bush-Francis Catatonia Rating Scale (BFCRS) were used to track clinical symptoms. Eighty-two individuals were enrolled in this study. Patients had lower BFCRS (MD: -6.68; 95% CI: -8.23, -5.14), CGI-S (MD: -1.27; 95% CI: -1.73, -0.81), and NPITS scores (MD: -6.50; 95% CI: -7.53, -5.47) while they were on therapy compared to baseline. Approximately 46% of the patients (n = 38) experienced neurologic relapse with wean of IVIg. Patients with neurologic relapse were more likely to have any abnormal neurodiagnostic study (χ2 = 11.82, P = 0.001), abnormal MRI (χ2 = 7.78, P = 0.005), and abnormal LP (χ2 = 5.45, P = 0.02), and a personal history of autoimmunity (OR: 6.11, P < 0.001) compared to patients without relapse. IVIg was highly effective in the treatment of DSRD. Individuals with a history of personal autoimmunity or neurodiagnostic abnormalities were more likely to relapse following weaning of immunotherapy, indicating the potential for, a chronic autoimmune etiology in some cases of DSRD.
Collapse
Affiliation(s)
- Jonathan D Santoro
- Division of Neurology, Children's Hospital Los Angeles, Los Angeles, CA, USA.
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
| | - Noemi A Spinazzi
- Department of Pediatrics, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Robyn A Filipink
- Division of Child Neurology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Panteha Hayati-Rezvan
- Division of Research on Children, Youth and Families, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Ryan Kammeyer
- Department of Neurology, Children's Hospital of Colorado, Aurora, CO, USA
| | - Lina Patel
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Elise A Sannar
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Luke Dwyer
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - Abhik K Banerjee
- Division of Neurology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Mellad Khoshnood
- Division of Neurology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Saba Jafarpour
- Division of Neurology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Natalie K Boyd
- Division of Neurology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Grace Y Gombolay
- Department of Pediatrics, Division of Neurology Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | - Diego Real de Asua
- Adult Down Syndrome Outpatient Clinic, Department of Internal Medicine, Fundación de Investigación Biomédica, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Melanie A Manning
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Heather Van Mater
- Division of Rheumatology, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Gordan Worley
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Cathy Franklin
- Queensland Center for Intellectual and Developmental Disability, Mater Research Institute, The University of Queensland, South Brisbane, QLD, Australia
| | - Maria A Stanley
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ruth Brown
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - George T Capone
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Eileen A Quinn
- Department of Pediatrics, University of Toledo College of Medicine and Life Science, Toledo, OH, USA
| | - Michael S Rafii
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
- Alzheimer's Therapeutic Research Institute (ATRI), Keck School of Medicine at the University of Southern California, San Diego, CA, USA
| |
Collapse
|
7
|
Banjar S, Kadour E, Khoudja R, Ton-Leclerc S, Beauchamp C, Beltempo M, Dahan MH, Gold P, Jacques Kadoch I, Jamal W, Laskin C, Mahutte N, Reinblatt SL, Sylvestre C, Buckett W, Genest G. Intravenous immunoglobulin use in patients with unexplained recurrent pregnancy loss. Am J Reprod Immunol 2023; 90:e13737. [PMID: 37491929 DOI: 10.1111/aji.13737] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/30/2023] [Accepted: 06/02/2023] [Indexed: 07/27/2023] Open
Abstract
PROBLEM Recurrent pregnancy loss (RPL) affects up to 4% of couples attempting to conceive. RPL is unexplained in over 50% of cases and no effective treatments exist. Due to the immune system's pivotal role during implantation and pregnancy, immune-mediated RPL may be suspected and immunomodulatory treatments like intravenous immunoglobulin (IVIg) have been administered but remain controversial. The goal of our study was to evaluate our center's 6 year-outcomes and to develop a framework for IVIg use in RPL. METHOD OF THE STUDY Retrospective, single-center cohort study. All patients having received IVIg for unexplained RPL at the McGill Reproductive Immunology Clinic (MRIC) from January 2014 to December 2020 were included if maternal age was <42 years, body mass index (BMI) < 35 kg/m2 , non-smoker and having had ≥3 consecutive RPL despite previous treatment with aspirin and progesterone. IVIg 0.6-0.8 g/kg was given prior to conception and monthly during pregnancy until 16-20 weeks' gestation. We compared IVIg treated patient's outcomes to a separate "natural history cohort". This cohort was composed of patients consulting at the McGill recurrent pregnancy loss clinic and the MRIC over a 2-year period (January 2020 to December 2021) with similar inclusion criteria as the treatment cohort but did not receive IVIg or other immunomodulatory treatments. The association of IVIg with outcomes (compared to no IVIg) was evaluated among the groups of patients with primary RPL and secondary RPL. The primary outcome was live birth rate (LBR), secondary outcomes included IVIg safety, obstetrical, and neonatal complications. RESULTS Among 169 patients with unexplained RPL that were included in the study, 111 had primary RPL (38 exposed to IVIg and 83 controls) and 58 had secondary RPL (nine exposed to IVIG and 49 controls). Among patients with primary RPL (n = 111), the LBR was 64.3% (18/28) among patient exposed to IVIg compared to 43.4% (36/83) in controls (p = 0.079); regression analysis adjusting for BMI and number of previous miscarriages showed benefit favoring the use of IVIg (OR = 3.27, CI 95% (1.15-10.2), p = 0.03) when evaluating for live birth. In the subgroup of patients with ≥5 previous RPL and primary RPL (n = 31), IVIg was associated with higher LBR compared to control (10/15 (66.7%) vs. 3/16 (18.8%); p = 0.0113) but not the in the sub-group of patients with <5 miscarriages and primary RPL (8/13 (61.5%) vs. 33/67 (49.3%); p = 0.548). IVIG treatment did not improve LBR in patients with secondary RPL in our study (3/9 (33.3%) vs. 23/49 (47%); p = 0.495). There were no serious adverse events in the IVIg treatment group, obstetrical/neonatal complications were similar between groups. CONCLUSION IVIg may be an effective treatment for patients with RPL if appropriately used in specific groups of patients. IVIg is a blood product and subject to shortages especially with unrestricted off-label use. We propose considering IVIg in well-selected patients with high order RPL who have failed standard medical therapy. Further mechanistic studies are needed to understand immune-mediated RPL and IVIg's mode of action. This will enable further refinement of treatment criteria and the development of standardized protocol for its use in RPL.
Collapse
Affiliation(s)
- Shorooq Banjar
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Division of Clinical Immunology and Allergy, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | - Einav Kadour
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Bnai-Zion Medical Center, Rishon-Le-Zion, Israel
- Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Rabea Khoudja
- Division of Clinical Immunology and Allergy, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | | | - Coralie Beauchamp
- Ovo Clinic, Montréal, Québec, Canada
- Obstetrics and Gynaecology Department, University of Montreal, Montreal, Quebec
| | - Marc Beltempo
- Division of Neonatology, Montreal Children's Hospital - McGill University Health Centre, Montreal, Québec, Canada
| | - Michael H Dahan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, McGill University, McGill University Health Centre, Montréal, Québec, Canada
| | - Phil Gold
- Department of Allergy and Immunology, Montreal General Hospital, Montreal, Quebec, Canada
| | - Isaac Jacques Kadoch
- Ovo Clinic, Montréal, Québec, Canada
- Obstetrics and Gynaecology Department, University of Montreal, Montreal, Quebec
| | - Wael Jamal
- Clinique OVO, Montréal, Québec, Canada
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Faculty of Medicine, University of Montreal, Montreal, Québec, Canada
| | - Carl Laskin
- TRIO Fertility, Toronto, Ontario, Canada
- Deptartments of Medicine and Obstetrics & Gynecology, University of Toronto, Toronto, Canada
| | - Neal Mahutte
- The Montreal Fertility Centre, Montreal, Quebec, Canada
| | - Shauna Leigh Reinblatt
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, McGill University, McGill University Health Centre, Montréal, Québec, Canada
| | - Camille Sylvestre
- Ovo Clinic, Montréal, Québec, Canada
- Division of Reproductive Endocrinology and Infertility, University of Montreal, Montreal, Quebec, Canada
| | - William Buckett
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, McGill University, McGill University Health Centre, Montréal, Québec, Canada
- McGill University Health Care Reproductive Center, Montreal, Quebec, Canada
| | - Genevieve Genest
- Division of Clinical Immunology and Allergy, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
| |
Collapse
|
8
|
Bayry J, Ahmed EA, Toscano-Rivero D, Vonniessen N, Genest G, Cohen CG, Dembele M, Kaveri SV, Mazer BD. Intravenous Immunoglobulin: Mechanism of Action in Autoimmune and Inflammatory Conditions. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1688-1697. [PMID: 37062358 DOI: 10.1016/j.jaip.2023.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 04/18/2023]
Abstract
Intravenous immunoglobulin (IVIG) is the mainstay of therapy for humoral immune deficiencies and numerous inflammatory disorders. Although the use of IVIG may be supplanted by several targeted therapies to cytokines, the ability of polyclonal normal IgG to act as an effector molecule as well as a regulatory molecule is a clear example of the polyfunctionality of IVIG. This article will address the mechanism of action of IVIG in a number of important conditions that are otherwise resistant to treatment. In this commentary, we will highlight mechanistic studies that shed light on the action of IVIG. This will be approached by identifying effects that are both common and disease-specific, targeting actions that have been demonstrated on cells and processes that represent both innate and adaptive immune responses.
Collapse
Affiliation(s)
- Jagadeesh Bayry
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Paris, France; Department of Biological Sciences and Engineering, Indian Institute of Technology Palakkad, Palakkad, India.
| | - Eisha A Ahmed
- Research Institute of McGill University Health Centre, Translational Program in Respiratory Diseases and Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Diana Toscano-Rivero
- Research Institute of McGill University Health Centre, Translational Program in Respiratory Diseases and Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Nicholas Vonniessen
- Research Institute of McGill University Health Centre, Translational Program in Respiratory Diseases and Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Genevieve Genest
- Research Institute of McGill University Health Centre, Translational Program in Respiratory Diseases and Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Casey G Cohen
- Research Institute of McGill University Health Centre, Translational Program in Respiratory Diseases and Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Marieme Dembele
- Research Institute of McGill University Health Centre, Translational Program in Respiratory Diseases and Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Srini V Kaveri
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Paris, France
| | - Bruce D Mazer
- Research Institute of McGill University Health Centre, Translational Program in Respiratory Diseases and Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, Canada.
| |
Collapse
|
9
|
Santoro J, Spinazzi N, Filipink R, Hayati-Rezvan P, Kammeyer R, Patel L, Sannar E, Dwyer L, Banerjee A, Khoshnood M, Jafarpour S, Boyd N, Partridge R, Gombolay G, Christy A, Real de Asua D, Del Carmen Ortega M, Manning M, Van Mater H, Worley G, Franklin C, Stanley M, Brown R, Capone G, Quinn E, Rafii M. Immunotherapy Responsiveness and Risk of Relapse in Down Syndrome Regression Disorder. RESEARCH SQUARE 2023:rs.3.rs-2521595. [PMID: 36824719 PMCID: PMC9949176 DOI: 10.21203/rs.3.rs-2521595/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Down syndrome regression disorder (DSRD) is a clinical symptom cluster consisting of neuropsychiatric regression without an identifiable cause. This study evaluated the clinical effectiveness of IVIg and evaluated clinical characteristics associated with relapse after therapy discontinuation. A prospective, multi-center, non-randomized, observational study was performed. Patients met criteria for DSRD and were treated with IVIg. All patients underwent a standardized wean off therapy after 9-12 months of treatment. Baseline, on therapy, and relapse scores of the Neuropsychiatric Inventory Total Score (NPITS), Clinical Global Impression-Severity (CGI-S), and the Bush-Francis Catatonia Rating Scale (BFCRS) were used to track clinical symptoms. Eighty-two individuals were enrolled in this study. Patients had lower BFCRS (MD: -6.68; 95% CI: -8.23, -5.14), CGI-S (MD: -1.27; 95% CI: -1.73, -0.81), and NPITS scores (MD: -6.50; 95% CI: -7.53, -5.47) while they were on therapy compared to baseline. Approximately 46% of the patients (n = 38) experienced neurologic relapse with wean of IVIg. Patients with neurologic relapse were more likely to have any abnormal neurodiagnostic study (χ2 = 11.82, p = 0.001), abnormal MRI (χ2 = 7.78, p = 0.005), and abnormal LP (χ2 = 5.45, p = 0.02), and a personal history of autoimmunity (OR: 6.11, p < 0.001) compared to patients without relapse. IVIg was highly effective in the treatment of DSRD. Individuals with a history of personal autoimmunity or neurodiagnostic abnormalities were more likely to relapse following weaning of immunotherapy, indicating the potential for, a chronic autoimmune etiology in some cases of DSRD.
Collapse
Affiliation(s)
| | | | | | | | - Ryan Kammeyer
- Kennedy-Krieger Institute and Johns Hopkins University
| | - Lina Patel
- Kennedy-Krieger Institute and Johns Hopkins University
| | - Elise Sannar
- Kennedy-Krieger Institute and Johns Hopkins University
| | - Luke Dwyer
- Kennedy-Krieger Institute and Johns Hopkins University
| | | | | | | | - Natalie Boyd
- Kennedy-Krieger Institute and Johns Hopkins University
| | | | | | | | | | | | | | | | - Gordon Worley
- Kennedy-Krieger Institute and Johns Hopkins University
| | | | - Maria Stanley
- Kennedy-Krieger Institute and Johns Hopkins University
| | - Ruth Brown
- Kennedy-Krieger Institute and Johns Hopkins University
| | - George Capone
- Kennedy-Krieger Institute and Johns Hopkins University
| | | | | |
Collapse
|
10
|
de Silvestro G, Catalano L, Marano G, Piccinini V, Cannata L, Ostuni A, de Angelis V. The Italian registry of therapeutic apheresis: year of activity 2021. Transfus Apher Sci 2023:103652. [PMID: 36804188 DOI: 10.1016/j.transci.2023.103652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/25/2023] [Accepted: 02/05/2023] [Indexed: 02/08/2023]
Abstract
In 2019, the Italian National Blood Center (NBC), at the request of the Italian Scientific Society of Haemapheresis and Cell Manipulation (SIdEM), included the Italian Registry of Therapeutic Apheresis (IRTA) in the Information System of Transfusion Services (SISTRA), whose activity is coordinated by the NBC. The IRTA provides institutions and scientific societies with a wide range of information including therapeutic procedures and outcomes of treated patients. The Italian National Health Service offers therapeutic apheresis for patients with various conditions, but it is mainly the patient with haematological and/or neurological disorders who turns to the apheresis centres as evidenced by the activity data of 2021. In the haematological field, the apheresis centres mainly supply haematopoietic stem cells for autologous or allogeneic transplantation as well as mononuclear cell collection for extracorporeal photopheresis (ECP), a therapeutic approach of II line in post-transplant Graft versus Host Disease. The activity of 2021 in the neurological field confirms the data of 2019, the pre-pandemic year, and indicates that myasthenia, chronic inflammatory demyelinating polyneuropathy and Guillain-Barré syndrome along with other neurological pathologies related to immune disorders are the diseases in which apheresis procedures are most used. In conclusion, the IRTA is a valuable tool for monitoring the activity of apheresis centres carried out at a national level and above all for providing an overall picture of how the use of this therapeutic tool evolves and changes over time.
Collapse
Affiliation(s)
- Giustina de Silvestro
- Italian Scientific Society of Haemapheresis and Cell Manipulation SIdEM, Pescara, Italy
| | - Liviana Catalano
- Italian National Blood Centre, National Institute of Health, Rome, Italy.
| | - Giuseppe Marano
- Centre of Reference for Gender Medicine, National Institute of Health, Rome, Italy
| | - Vanessa Piccinini
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Livia Cannata
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Angelo Ostuni
- Italian Scientific Society of Haemapheresis and Cell Manipulation SIdEM, Pescara, Italy
| | | |
Collapse
|
11
|
The Missing Pieces to the Cold-Stored Platelet Puzzle. Int J Mol Sci 2022; 23:ijms23031100. [PMID: 35163024 PMCID: PMC8835703 DOI: 10.3390/ijms23031100] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 01/28/2023] Open
Abstract
Cold-stored platelets are making a comeback. They were abandoned in the late 1960s in favor of room-temperature stored platelets due to the need for longer post-transfusion platelet recoverability and survivability in patients with chronic thrombocytopenia. However, the current needs for platelet transfusions are rapidly changing. Today, more platelets are given to patients who are actively bleeding, such as ones receiving cardiac surgeries. It has been established that cold-stored platelets are more hemostatically effective, have reduced bacterial growth, and have longer potential shelf lives. These compelling characteristics led to the recent interest in bringing back cold-stored platelets to the blood systems. However, before reinstating cold-stored platelets in the clinics again, a thorough investigation of in vitro storage characteristics and in vivo transfusion effects is required. This review aims to provide an update on the recent research efforts into the storage characteristics and functions of cold-stored platelets using modern investigative tools. We will also discuss efforts made to improve cold-stored platelets to be a better and safer product. Finally, we will finish off with discussing the relevance of in vitro data to in vivo transfusion results and provide insights and directions for future investigations of cold-stored platelets.
Collapse
|