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Long-term follow-up patients with leukemia receiving platelet transfusions:
identification of a large group of patients who do not become alloimmunized
JP Dutcher, CA Schiffer, J Aisner and PH Wiernik
Alloimmunization is the major complication of platelet transfusion therapy
in patients with acute leukemia. To evaluate whether alloimmunization
continues to be a long-term problem in patients surviving induction
therapy, 114 patients with acute nonlymphocytic leukemia (ANLL) who
survived more than 6 mo and who received multiple courses of chemotherapy
and abundant platelet transfusions were studied. Clinical response to
random donor platelets and lymphocytotoxic antibody (LCTAb) were measured
pretreatment and serially throughout the study period. Fourteen patients
(12%) were alloimmunized upon admission, 34 (30%) patients became
alloimmunized during remission induction therapy, and 66 (58%) patients did
not become alloimmunized during that period. Sixty-one of these 66 patients
(92%) never became alloimmunized and responded to random donor platelets
during their subsequent course despite the fact they received multiple
further platelet transfusions, whereas the alloimmunized patients tended to
remain alloimmunized for their entire clinical course. There was no
difference in age or sex between groups, and prognostic factors predicting
alloimmunization could not be detected. In greater than 90% of patients not
alloimmunized at admission, the presence or absence of LCTAb after
induction predicts later alloantibody production. This information can be
used to plan the type of platelet transfusions (HLA-matched or random
donor) needed for subsequent maintenance and induction therapy. It may also
help to identify a group of patients to whom more aggressive maintenance
chemotherapy may be more safely administered.
Volume 58,
Issue 5,
pp. 1007-1011,
11/01/1981
Copyright © 1981 by The American Society of Hematology
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