Red cell alloimmunization is associated with development of autoantibodies and increased red cell transfusion requirements in myelodysplastic syndrome.

This study evaluates the incidence and clinical impact of red cell alloimmunization in a large cohort of myelodysplastic syndrome patients registered in the statewide South Australian-MDS registry. Median age of the 817 patients was 73 years, and 66% were male. The cumulative incidence of alloimmunization was 11%. Disease-modifying therapy was associated with a lower risk of alloimmunization. While alloimmunization was significantly higher in IPSS-R Very Low, Low and Intermediate risk groups compared to High and Very High groups (p=0.03). Alloantibodies were most commonly directed against antigens in the Rh (54%) and Kell (24%) systems. Multiple alloantibodies were present in 49% of alloimmunized patients. Though 73% of alloimmunized patients developed alloantibodies during their first 20 red cell units, total units transfused were significantly higher in alloimmunized compared to non-alloimmunized patients (90±100 vs. 30+/-52; p<0.0001). In individual patients, requirements for red cell transfusion intensity significantly increased following alloimmunization (2.8&+/-1.3 vs. 4.1+/-2.0; p<0.0001). Significantly higher proportion of alloimmunized patients had detectable autoantibodies than non-alloimmunized patients (65% vs. 18%; p<0.0001) and the majority of autoantibodies were detected within a short-period of alloimmunization. This study characterises alloimmunization in a large cohort of myelodysplastic syndrome patients and demonstrates a signficant increase ...

Source: Haematologica - October 5, 2017 Category: Hematology Authors: Singhal D, Kutyna MM, Chhetri R, Wee LYA, Hague S, Nath L, Nath SV, Sinha R, Wickham N, Lewis ID, Ross DM, Bardy PG, To LB, Reynolds J, Wood EM, Roxby DJ, Hiwase DK Tags: Haematologica Source Type: research