Transfusion of pathogen-reduced platelet components without leukoreduction

Area of Science:

• Transfusion Medicine
• Hematology
• Immunology

Background:

• Leukoreduction (LR) of platelet concentrate (PC) is standard for mitigating transfusion risks but does not prevent transfusion-associated graft-versus-host disease (TA-GVHD).
• Amotosalen-ultraviolet A pathogen reduction (A-PR) of PC inactivates WBCs and pathogens, reducing transfusion-transmitted infections and TA-GVHD risk.

Purpose of the Study:

• To evaluate the feasibility and efficacy of A-PR processed PC without LR, gamma irradiation, or bacterial screening in hematopoietic stem cell transplant (HSCT) recipients.
• To compare the safety and efficacy of A-PR PC versus conventional PC in HSCT patients.

Main Methods:

• A sequential cohort study compared conventional PC (control) with A-PR PC (test) in HSCT recipients.
• Primary outcomes included 1-hour corrected count increment and treatment-emergent acute transfusion reactions (ATRs).
• Secondary outcomes assessed clinical refractoriness, engraftment, TA-GVHD, HSCT-GVHD, infections, and mortality at 100 days.

Main Results:

• Mean corrected count increment was similar between A-PR PC and control PC groups (18.9 ± 8.8 vs. 16.6 ± 8.4).
• A-PR PC showed a nonsignificant reduction in ATR incidence (9.1% vs. 19.4%) and significantly lower frequencies of clinical refractoriness (0% vs. 12.9%) and refractory transfusions (6.6% vs. 19.3%).
• No TA-GVHD was observed in either cohort; 100-day engraftment, HSCT-GVHD, mortality, and infectious complications were comparable.

Conclusions:

• A-PR PC processed without LR, gamma irradiation, or bacterial screening is a feasible option for supporting HSCT recipients.
• This approach offers potential benefits in reducing transfusion reactions and refractoriness.
• Further research may support broader adoption of A-PR as a replacement for traditional LR processing.