Background We conducted a multi-institutional, randomized, blindedtrial to determine whether the use of platelets from which leukocyteshad been removed by a filter or that had been treated with ultravioletB irradiation would prevent the formation of antiplatelet alloantibodiesand refractoriness to platelet transfusions.
Methods Patients who were receiving induction chemotherapy foracute myeloid leukemia were randomly assigned to receive oneof four types of platelet transfusions: unmodified, pooled plateletconcentrates from random donors (control); filtered, pooledplatelet concentrates from random donors (F-PC); ultravioletB–irradiated, pooled platelet concentrates from randomdonors (UVB-PC); or filtered platelets obtained by apheresisfrom single random donors (F-AP). All patients received transfusionsof filtered, leukocyte-reduced red cells.
Results Of 530 patients with no alloantibodies at base line,13 percent of those in the control group produced lymphocytotoxicantibodies and their thrombocytopenia became refractory to platelettransfusions, 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<0.001for each treated group as compared with the controls; therewere no significant differences among the treated groups). Antibodiesagainst platelet glycoproteins developed in 6 to 11 percentof the patients, with no significant differences among the fourgroups.
Conclusions Reduction of leukocytes by filtration and ultravioletB irradiation of platelets are equally effective in preventingalloantibody-mediated refractoriness to platelets during chemotherapyfor acute myeloid leukemia. Platelets obtained by apheresisfrom single random donors provided no additional benefit ascompared with pooled platelet concentrates from random donors.
Source Information
Dr. Slichter assumes responsibility for the overall content and integrity of the manuscript.
Address reprint requests to Dr. Sherrill J. Slichter at the Division of Research and Education, Puget Sound Blood Center, 921 Terry Ave., Seattle, WA 98104-1256.
Prophylactic Platelet Transfusions in Acute Myeloid Leukemia
Gratwohl A., Tichelli A., Atkins C. D., Rebulla P., Marangoni F., Sirchia G., Slichter S. J., Schiffer C. A., Davis K. A.B., The Trial to Reduce Alloimmunization to Platelets Study Group
Extract |
Full Text
N Engl J Med 1998;
338:1468-1470, May 14, 1998.
Correspondence
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