Treatments for hematologic malignancies in contrast to those for solid cancers are associated with reduced red cell alloimmunization
Dorothea Evers,
Jaap Jan Zwaginga,
Janneke Tijmensen,
Rutger A. Middelburg,
Masja de Haas,
Karen M.K. de Vooght,
Daan van de Kerkhof,
Otto Visser,
Nathalie C.V. Péquériaux,
Francisca Hudig,
Johanna G. van der Bom
Affiliations
Dorothea Evers
Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands;Department of Immuno-hematology and Blood Transfusion, Leiden University Medical Center, the Netherlands
Jaap Jan Zwaginga
Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands;Department of Immuno-hematology and Blood Transfusion, Leiden University Medical Center, the Netherlands
Janneke Tijmensen
Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands;Department of Immuno-hematology and Blood Transfusion, Leiden University Medical Center, the Netherlands
Rutger A. Middelburg
Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands;Department of Clinical Epidemiology, Leiden University Medical Center, the Netherlands
Masja de Haas
Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands;Department of Immuno-hematology and Blood Transfusion, Leiden University Medical Center, the Netherlands;Department of Immunohematology Diagnostics, Sanquin, Amsterdam, the Netherlands
Karen M.K. de Vooght
Department of Clinical Chemistry and Hematology, University Medical Center, Utrecht, the Netherlands
Daan van de Kerkhof
Department of Clinical Chemistry and Hematology, Catharina Hospital, Eindhoven, the Netherlands
Otto Visser
Department of Hematology, VU Medical Center, Amsterdam, the Netherlands
Nathalie C.V. Péquériaux
Department of Clinical Chemistry and Hematology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands
Francisca Hudig
LabWest, Haga Teaching Hospital, The Hague, the Netherlands
Johanna G. van der Bom
Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands;Department of Clinical Epidemiology, Leiden University Medical Center, the Netherlands
Red cell alloimmunization may induce severe hemolytic side effects. Identification of risk-modifying conditions will help tailor preventative strategies. This study aims to quantify the associations of hematologic malignancies and solid cancers with red cell alloimmunization in patients receiving red cell transfusions. We performed a nested multicenter case-control study in a source population of 24,063 patients receiving their first and subsequent red cell transfusions during an 8-year follow-up period. Cases (n=505), defined as patients developing a first transfusion-induced red cell alloantibody, were each compared with 2 non-alloimmunized controls (n=1010) who received a similar number of red cell units. Using multivariate logistic regression analyses, we evaluated the association of various malignancies and treatment regimens with alloimmunization during a delineated 5-week risk period. The incidence of alloimmunization among patients with acute (myeloid or lymphoid) leukemia and mature (B- or T-cell) lymphoma was significantly reduced compared to patients without these malignancies: adjusted relative risks (RR) with 95% confidence interval (CI) 0.36 (range 0.19–0.68) and 0.30 (range 0.12–0.81). Associations were primarily explained by immunosuppressive treatments [RR for (any type of) chemotherapy combined with immunotherapy 0.27 (95%CI: 0.09–0.83)]. Alloimmunization risks were similarly diminished in allogeneic or autologous stem cell transplanted patients (RR 0.34, 95%CI: 0.16–0.74), at least during the six months post transplant. Alloimmunization risks of patients with other hematologic diseases or solid cancers, and their associated treatment regimens were similar to risks in the general transfused population. Our findings suggest that, in contrast to malignancies in general, hemato-oncological patients treated with dose-intensive regimens have strongly diminished risk of red cell alloimmunization.
