The Analysis of Patients with Refractoriness to Platelet Transfusion Due to Anti-HLA Antibodies During the Treatment of Acute Leukemia

Refractoriness to platelet transfusion is one of complications during the treatment of acute leukemia. The major reason is destruction of transfused platelets by anti-human leukocyte antigen (HLA) antibodies to HLA on donor’s platelets. We investigated retrospectively the incidence and characteristics of patients with refractoriness to platelet transfusion due to anti-HLA antibodies during the treatment of acute leukemia.

From 2000 to 2010, 348 acute leukemia patients underwent chemotherapy at our hospital. Among them, we surveyed 325 patients who received platelet transfusions more than five times. Examination of anti-HLA antibodies was performed when clinically an attending physician suspected that platelet transfusion was not effective. The existence of anti-HLA antibodies were tested both lymphocyte cytotoxicity test (LCT) and anti human immunoglobulin-LCT (AHG-LCT).

Of the 325 patients, males were 186, and female were 139. Two hundred sixty-three patients and 62 patients suffered from acute myeloid leukemia (AML) and acute lymphocytic leukemia (ALL), respectively. The median age of all patients was 57 (15–86) years. All patients had received red blood cell and platelet products from which leukocytes were removed by filtration. Of all patients, 23 (7.1%) were positive for anti-HLA antibodies. The median age of patients with anti-HLA antibodies was 57(24–76) years. The number of male and female were 2(8.7%) and 21 (91.3 %), respectively. All female patients with anti-HLA antibody had a history of delivery. 8.3 % of AML patients and 1.6% of ALL patients were positive for anti-HAL antibodies.The median number of platelet transfusions until the presence of anti-HLA antibodies was 11 (4–48). The median date of anti-HLA antibodies detection was 27(8–263) days after first platelet transfusion. After detection of anti-HLA antibodies, all patients with anti-HLA antibodies received HLA-matched platelets, and fatal bleeding was not seen. History of delivery (p<0.001), AML (p=0.0147) and age over 50 years (p=0.0490) were risk factors for the presence of anti-HLA antibodies. The presence of anti-HLA antibodies had no impact for the survival (p=0.6033).

During chemotherapy for the treatment of acute leukemia, 7% of patients suffered from refractoriness to platelet transfusion due to ant-HLA antibodies. The frequency was low compared with other blood disorders. Elderly AML patients with a history of delivery tended to produce anti-HLA antibodies. Patients with anti-HLA antibodies could obtain similar outcomes by using HLA-matched platelets, comparing with patients without anti-HLA antibodies.

No relevant conflicts of interest to declare.