Transfusion-associated graft-versus-host disease: A concise review

Area of Science:

• Hematology
• Transfusion Medicine
• Immunology

Background:

• Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare but fatal complication.
• It affects immunocompromised and immunocompetent individuals, presenting with pancytopenia and multiorgan failure.
• Pathogenesis involves donor T lymphocyte proliferation, engraftment, and host tissue attack.

Purpose of the Study:

• To analyze international guidelines for irradiating cellular blood components to prevent TA-GVHD.
• To compare clinical indications in American, Australian, British, and Japanese transfusion guidelines.
• To review the literature on TA-GVHD prevention strategies.

Main Methods:

• A narrative review of PubMed articles published between January 2000 and July 2018.
• Comparison of international transfusion guidelines regarding irradiation indications.
• Analysis of documented TA-GVHD cases and emerging prevention strategies.

Main Results:

• Gamma or X irradiation of cellular blood products is the established standard of care for TA-GVHD prevention.
• Pathogen inactivation technologies demonstrate safety and efficacy against white blood cells and T cells.
• Guidelines vary across countries regarding specific clinical indications for irradiation.

Conclusions:

• Irradiation remains the primary method for preventing TA-GVHD.
• Pathogen inactivation offers a potential alternative or adjunct preventive strategy.
• Further research is needed to refine T cell immunocompetence assessment and optimize prevention protocols.