Peritransplantation Red Blood Cell Transfusion Is Associated with Increased Risk of Graft-versus-Host Disease after Allogeneic Hematopoietic Stem Cell Transplantation

• Type of Material: Article
• Authors: Sakura Hosoba, Emory University; Edmund K Waller, Emory University; Neeta Shenvi, Emory University; Michael Graiser, Emory University; Kirk Easley, Emory University; Zaid Al-Kadhimi, Emory University; Akira Andoh, Shiga University of Medical Science; Ana G Antun, Emory University; Sheliagh Barclay, Emory University; Cassandra D Josephson, Emory University; Jean Louise Koff, Emory University; H.Jean Khoury, Emory University; Amelia A Langston, Emory University; James Zimring, Emory University; John D Roback, Emory University; Cynthia R Giver, Emory University
• Language: English
• Date: 2018-05-01
• Publisher: Elsevier: 12 months
• Publication Version: Final Published Version
• Copyright Statement: © 2018 The American Society for Blood and Marrow Transplantation
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.bbmt.2018.01.003
• Title of Journal or Parent Work: Biology of Blood and Marrow Transplantation
• ISSN: 1083-8791
• Volume: 24
• Issue: 5
• Start Page: 973
• End Page: 982
• Grant/Funding Information: This study received funding from NIH NHLBI Program Project Grant P01 HL086773
• Keywords: SURVIVAL; Life Sciences & Biomedicine; Transplantation; ANTIGENS; Immunology; Science & Technology; GVHD; RBC transfusion; Allogeneic HSCT; ACUTE GVHD; Graft-versus-host disease; BONE-MARROW; DENDRITIC CELLS; THROMBOCYTOPENIC PATIENTS; UNRELATED DONORS; Allogeneic BMT; Blood transfusion; MHC CLASS-I; Hematology; T-CELLS; PLATELET TRANSFUSION
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Pathology

Abstract

More than 90% of allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients receive red blood cell (RBC) or platelet transfusions in the peritransplantation period. We tested the hypothesis that transfusions are associated with the development of severe (grade III-IV) acute graft-versus-host disease (aGVHD) or mortality after allo-HSCT in a retrospective study of 322 consecutive patients receiving an allogeneic bone marrow or granulocyte colony-stimulating factor-mobilized blood stem cell graft for a hematologic malignancy. Counting transfused RBC and platelet units between day −7 pretransplantation and day +27 post-transplantation, but excluding transfusions administered after a diagnosis of aGVHD, yielded medians of 5 RBC units and 2 platelet units transfused. Sixty-three patients (20%) developed a maximal grade III-IV aGVHD with onset up to day +150 post-transplantation (median aGVHD onset of 28 days). HLA mismatch (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.2 to 4.7; P =.01), and transfusion of more than the median number of RBC units (HR, 2.1; 95% CI, 1.1 to 3.7; P =.02) were independently associated with greater risk of grade III-IV aGVHD in a multivariable analysis model. Disease risk strata (HR, 1.7; 95% CI, 1.2 to 2.4 for high risk versus low risk; P =.005) and transfusion of more than the median number of RBC units (HR, 1.4; 95% CI, 1.0 to 2.0; P =.054) were independently associated with inferior overall survival. These data support our hypothesis that peritransplantation RBC transfusions are associated with the risk of developing severe aGVHD and worse overall survival following allo-HSCT, and suggest that strategies to reduce routine RBC transfusion may favorably reduce the incidence and severity of GVHD.