Transfusion Related Alloimmunization In Children: Epidemiology and Effects Of Chemotherapy (TRACE-EC Study)
Notice bibliographique
Résumé
Abstract Introduction Pediatric hematology/oncology patients require numerous transfusions during myelosuppressive chemotherapy which may lead to red cell (RC) alloantibody formation. However, transfusion related alloimmunization in children has not been studied except in the neonatal and hemoglobinopathy populations. Variability of RC alloimmunization rates by cancer diagnosis has not been described and the immunosuppressive effect of chemotherapy on alloimmunization is unknown. One study has shown a reduction in IgM and IgG in pediatric leukemia patients receiving chemotherapy (Martín Ibáñez et al Allergol Immunopathol 2003); hence, one could hypothesize that chemotherapy could suppress the alloimmune response. This study aimed to: 1) report the rate of alloimmunization in children receiving RC transfusions, 2) compare these rates between oncology and non-oncology patients, and 3) compare these rates based on cancer diagnosis and stage. Methods TRACE-EC was a retrospective observational study using a large database containing patient blood utilization information from 3 academic hospitals. Patient inclusion criteria included: age ≥ 4 months and ≤ 17 years old at the time of receiving ³ 1 non-autologous RC transfusion between April 2002 and November 2011. Diagnoses were identified using ICD10 codes. Patients with immune disorders were excluded. Study patient cohort included patients with malignancies and recipients of hematopoietic stem cell transplant (HSCT) to treat a malignancy; control cohort included non-oncology patients who met the inclusion criteria. Patient and blood utilization data were extracted from the database, and chemotherapy data were obtained by retrospective review of patient medical records. Study patients were stratified for analysis based on cancer diagnosis and stage (surrogate for chemotherapy intensity). Cancer stage was categorized as low level (I, II, standard risk) and high level (III, IV, V, high risk). Control patients with hemoglobinopathy were analyzed separately due to their high alloimmunization rate (Aygun et al. Transfusion 2002). Results There were 1253 patients in the study: 944 in control group; 309 in study group. Females made up 49% of control group and 43% of study group. Mean age was 8.6 years (SD 6.4) in control group, and 7.2 years (SD 5.5) in study group. The frequency of alloimmunization and RC utilization by diagnosis in control and study groups is summarized in Table 1. Overall, a statistical difference in the frequency of alloimmunization was not demonstrated between control patients (4.3%) and study patients (5.5%), p=0.40. When hemoglobinopathy patients were removed from the control group, frequency of alloimmunization decreased to 3.8% (p=0.19). Alloimmunization occurred in 5.4% (10/186) and 5.7% (7/123) of patients with a high level and low level cancer stage respectively, p=0.91. HSCT recipients had a higher rate of alloimmunization than non-HSCT but this was not statistically significant (11.4% vs. 4.5% respectively, p=0.07). Alloimmunization occurred in 4.9% of patients with hematologic malignancies and 7.1% of patients with solid tumors (p=0.44). Conclusions This is the first study that has looked at the frequency of alloimmunization in transfused pediatric patients by diagnostic category and cancer stage. The study confirmed high alloimmunization rates in hemoglobinopathy patients. No difference in the frequency of alloimmunization was observed based on cancer diagnosis, stage, or HSCT status. Further studies are needed to assess the effect on alloimmunization of the high RC utilization rate shown in cancer patients and HSCT recipients. Disclosures: Heddle: Health Canada: Research Funding; Canadian Blood Services: Membership on an entity’s Board of Directors or advisory committees, Research Funding; CIHR: Research Funding.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».