Prevention of Transfusion-Associated Graft-Versus-Host Disease With Blood Product Irradiation: The Past, Present, and Future

Abstract

Transfusion-associated graft-versus-host disease (TA-GVHD) is a disease with a very high mortality rate. In this report, we discuss TA-GVHD from a historical perspective, highlight the pathogenesis of TA-GVHD, and emphasize the importance of blood product irradiation, which is a very effective means to prevent this disease. We summarize the current recommendations in different patient populations from different countries and review recent developments, such as alternatives for the use of radioactive materials. We also speculate on future directions.

Educational Case: Granulocyte Transfusion

“…Due to the risk of TA-GVHD, all granulocyte products should be irradiated to prevent T-cell duplication in the recipient. 15 Transfusion reactions that are seen with other blood products can also be caused by granulocyte transfusion including febrile nonhemolytic, hemolytic, allergic, and septic reactions in addition to transfusion-associated circulatory overload (TACO).…”

Transfusion-associated graft-versus-host disease: A concise review

“…Controversies regard which cellular blood products are more commonly involved in the reaction and additional possible risk categories for TA-GVHD remain after literature search. 11-14 Granulocyte units, which contain more lymphocytes (10×10 9 lymphocytes per unit), 28 represent a cellular blood component used in selected cases. 32-35 Similarly, fresh whole blood (2×10 9 lymphocytes per unit), 28 which represents a possible therapy for trauma resuscitation, 36 , 37 should cause the complication due to a recognized decrease of lymphocytes activity after 2 weeks.…”

“…Few data regard the minimum number of lymphocytes necessary to cause TAGVHD. 11 , 12 According to Kopolovic and colleagues, cellular blood components involved in this fatal complication were whole blood (2×10 9 lymphocytes per unit), 28 leukoreduced components (5×10 6 lymphocytes per unit) 28 and component age inferior to 48 hours. 27 …”

Establishing the hematopoietic stem cell transplant (HSCT) in a developing country; the journey of HSCT in Semarang, Indonesia

“…Patients being treated according to our BMT protocol are treated with filtered and irradiated blood products. Irradiated products are cytomegalovirus-safe, have a reduced risk of nonhemolytic febrile transfusion and alloimmunization, and have a reduced incidence of transfusion-associated graft vs host disease in at-risk individuals [18][19][20][21].…”