Variation in blood component irradiation practice: implications for prevention of transfusion-associated graft-versus-host disease

Abstract

RAFT-VERSUS-HOST DISEASE (GVHD) is comG monly observed after allogeneic bone marrow transplantation (BMT), but transfusion-associated (TA) GVHD is only rarely reported. Although early reports of TAGVHD were recognized in immunocompromised hosts, more recent cases have been documented in immunocompetent transfusion recipients. The increasing awareness of this serious complication of transfusion prompted a national survey of transfusion medicine practices to identify patients at risk for TA-GVHD and assess methods for its prevention. HISTORICAL PERSPECTIVE The reported cases of TA-GVHD have recently been summarized.' To date, it has been documented after transfusion of unirradiated blood components to at least 87 patients: in patients with severe combined immunodeficiency, thymic hypoplasia, and Wiskott Aldrich syndrome2.'*; premature newborns and those with erythroblastosis fetali~'~-*~; patients with hematologic malignancies including Hodgkin's and non-Hodgkin's lymphomas, acute myelocytic and lymphoblastic leukemias, chronic lymphocytic leukemia, and aplastic patients with solid tumors including neuroblastomas, glioblastoma, rhabdomyosarcoma, cervical carcinoma, small cell lung cancer, and germ cell tum08'-'~; patients after cardiac surgery and cholecystectomp-60; and in an apparently healthy 22-year-old woman.6' This syndrome has developed after neonatal exchange and intrauterine transfusions; and after transfusion of whole blood, fresh (nonfrozen) plasma, red blood cells, and platelets. Leukocytes harvested from normal donors and from donors with chronic myelocytic leukemia transfused to patients with hematologic malignancies have also been implicated in TA-GVHD. TA-GVHD results in an overall mortality of 84% at a median of 21 (8 to 1,050) days after transfusion.'