Allogenic leukocyte immunization after five or more miscarriages. Recurrent Miscarriage Immunotherapy Trialists Group

Area of Science:

• Reproductive Immunology
• Obstetrics and Gynecology
• Immunotherapy

Background:

• Recurrent miscarriage (RM) poses a significant challenge in reproductive medicine.
• Paternal leukocyte immunization has been explored as a treatment for RM.
• Previous studies have yielded mixed results, necessitating further analysis of specific patient subgroups.

Purpose of the Study:

• To evaluate the efficacy of paternal leukocyte immunization in improving live birth rates.
• Focus on women with a history of five or more abortions and absence of anti-paternal complement-dependent antibody (APCA).
• Analyze outcomes in primary, secondary, and tertiary aborters.

Main Methods:

• Retrospective analysis of patients treated over 8 years.
• Inclusion of data from randomized and non-randomized trials by the Recurrent Miscarriage Immunotherapy Trialists Group.
• Classification of patients into primary, secondary, and tertiary aborters based on pregnancy history and live birth events.

Main Results:

• Immunization doubled the live birth rate in 107 primary aborters (31% absolute benefit).
• Achieved a nearly 3-fold increase in live birth rate for 45 tertiary aborters (50% absolute benefit).
• Minimal benefit observed in secondary aborters; significant efficacy in preventing abortion for primary/tertiary aborters with ≥5 abortions.

Conclusions:

• Paternal leukocyte immunization is an effective treatment for preventing abortions in specific RM patient groups.
• The number needed to treat for one additional live birth is low (2-4) for primary and tertiary aborters.
• This immunotherapy represents a valuable option for women with poor pregnancy outcomes due to recurrent miscarriage.