Comparative risk of pulmonary adverse events with transfusion of pathogen reduced and conventional platelet components

Edward L. Snyder, Allison P. Wheeler, Majed Refaai, Claudia S. Cohn, Jessica Poisson, Magali Fontaine, Mary Sehl, Ajay K. Nooka, Lynne Uhl, Philip Spinella, Maly Fenelus, Darla Liles, Thomas Coyle, Joanne Becker, Michael Jeng, Eric A. Gehrie, Bryan R. Spencer, Pampee Young, Andrew Johnson, Jennifer J. O'BrienGary J. Schiller, John D. Roback, Elizabeth Malynn, Ronald Jackups, Scott T. Avecilla, Jin Sying Lin, Kathy Liu, Stanley Bentow, Ho Lan Peng, Jeanne Varrone, Richard J. Benjamin, Laurence M. Corash

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Platelet transfusion carries risk of transfusion-transmitted infection (TTI). Pathogen reduction of platelet components (PRPC) is designed to reduce TTI. Pulmonary adverse events (AEs), including transfusion-related acute lung injury and acute respiratory distress syndrome (ARDS) occur with platelet transfusion. Study design: An open label, sequential cohort study of transfusion-dependent hematology-oncology patients was conducted to compare pulmonary safety of PRPC with conventional PC (CPC). The primary outcome was the incidence of treatment-emergent assisted mechanical ventilation (TEAMV) by non-inferiority. Secondary outcomes included: time to TEAMV, ARDS, pulmonary AEs, peri-transfusion AE, hemorrhagic AE, transfusion reactions (TRs), PC and red blood cell (RBC) use, and mortality. Results: By modified intent-to-treat (mITT), 1068 patients received 5277 PRPC and 1223 patients received 5487 CPC. The cohorts had similar demographics, primary disease, and primary therapy. PRPC were non-inferior to CPC for TEAMV (treatment difference −1.7%, 95% CI: (−3.3% to −0.1%); odds ratio = 0.53, 95% CI: (0.30, 0.94). The cumulative incidence of TEAMV for PRPC (2.9%) was significantly less than CPC (4.6%, p =.039). The incidence of ARDS was less, but not significantly different, for PRPC (1.0% vs. 1.8%, p =.151; odds ratio = 0.57, 95% CI: (0.27, 1.18). AE, pulmonary AE, and mortality were not different between cohorts. TRs were similar for PRPC and CPC (8.3% vs. 9.7%, p =.256); and allergic TR were significantly less with PRPC (p =.006). PC and RBC use were not increased with PRPC. Discussion: PRPC demonstrated reduced TEAMV with no excess treatment-related pulmonary morbidity.

Original languageEnglish (US)
Pages (from-to)1365-1376
Number of pages12
JournalTransfusion
Volume62
Issue number7
DOIs
StatePublished - Jul 2022

Bibliographical note

Funding Information:
The authors acknowledge the substantial contribution to the study by the pulmonary expert panel: Chairman, Ednan Bajwa, MD, MPH, Roy Brower, MD, Todd Rice, MD, MSc, and Boyd Taylor Thompson, MD. Staff at the study site blood centers provided study platelet components to enable the study. Therese Chlebeck provided additional support for the study at the University of Minnesota.

Publisher Copyright:
© 2022 Cerus Corporation. Transfusion published by Wiley Periodicals LLC on behalf of AABB.

Keywords

  • assisted mechanical ventilation
  • pathogen reduction
  • platelet transfusion
  • pulmonary adverse events

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't

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