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Updated: Jul 7, 2026
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Published on: May 26, 2021
Transfusion-Associated Graft-Versus-Host Disease Risk and Transfusion Requirements After Cladribine in Multiple
Klaus Schmierer1,2, Frederick Chen3, David Paling4
1The Blizard Institute, Queen Mary University of London, Faculty of Medicine & Dentistry, London, UK.
Background:
Irradiation of cellular blood components prevents transfusion-associated graft-versus-host disease (TA-GVHD). UK and Spanish guidance recommend lifelong irradiation for all patients treated with purine analogues, including cladribine, irrespective of indication or dose.
Objective:
To assess whether this approach is justified for people with multiple sclerosis (pwMS) receiving cladribine.
Methods:
Narrative synthesis of immunological data, hemovigilance evidence, and national European transfusion guidelines.
Results:
Cladribine used in pwMS induces transient lymphopenia with modest, reversible T-cell effects and preserved vaccine responsiveness. Since introduction of universal pre-storage leucocyte depletion, hemovigilance data show no reported cases of TA-GVHD in this setting. European guidance is heterogeneous, ranging from indefinite to time-limited or unspecified durations.
Conclusion:
Current evidence does not clearly support the need for lifelong irradiation after cladribine treatment in pwMS. Time-limited or individualized approaches merit consideration.
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