Reducing the Risk of TA-GVHD:
Transfusion-Associated Graft-versus-Host Disease (TA-GVHD) is a rare complication in which the viable T cells from the donor engraft and subsequently attacks the recipient’s cells. TA-GVHD is generally thought to occur only in immuno-compromised patients, but there are cases reported in immunocompetent individuals.1,2
Ability to reduce the risk of TA-GVHD is based on halting T-cell replication either by:
- Leukofiltration (considered ineffective based on case reports of TA-GVHD with leukoreduced products)3
- Contaminating T-cell reduction
- INTERCEPT treatment6
Irradiation has been approved for many years as a means to reduce TA-GVHD risk. However, T-cell activity studies have shown that gamma irradiation only partially inhibits markers of activity, mainly cytokine accumulation. In the same study, pathogen reduction eliminated this cytokine accumulation.5
Figure: Comparison between gamma irradiation and psoralen/UVA treatment.6,7
FDA and AABB Standard 188.8.131.52 accept INTERCEPT as an alternative to gamma irradiation for the prevention of TA-GVHD*.8,9
AABB Standards for Prevention of TA-GVHD
AABB standard 184.108.40.206 cites the “acceptable methods known to prevent transfusion-associated graft-vs-host disease include irradiation and pathogen reduction technology known to inactivate residual leukocytes that is cleared or approved by the FDA or Competent Authority.”8
- McMilin, K. and R. Johnson, HLA homozygosity and the risk of related-donor transfusion-associated graft-versus-host disease. Transfus Med Rev, 1993. 7(1): p. 37-41.
- Thaler , M., et al., The Role of Blood from HLA-Homozygous Donors in Fatal Transfusion-Associated Graft-versus-Host Disease after Open-Heart Surgery. New England Journal of Medicine, 1989. 321(1): p. 25-28.
- Kopolovic, I., et al., A systematic review of transfusion-associated graft-versus-host disease. Blood, 2015. 126(3): p. 406-14.
- AABB. Circular of Information for the Use of Human Blood and Blood Components. Bethesda, MD: AABB; 2017
- Hei, D.J., et al., Elimination of cytokine production in stored platelet concentrate aliquots by photochemical treatment with psoralen plus ultraviolet A light. Transfusion, 1999. 39(3): p. 239-48.
- Grass JA, Hei DJ, Metchette K, et al. Inactivation of leukocytes in platelet concentrates by photochemical treatment with psoralen plus UVA. Blood 1998;91:2180-8.
- Setlow R, Setlow J. Effects of radiation on polynucleotides. Annu Rev Biophys Bioeng 1972;1:293-346.
- The INTERCEPT Blood System for Platelets Package Insert, Cerus Corporation; July 17, 2018.
- “Standards for Blood Banks and Transfusion Services,” AABB, 31th edition, 2018.