Service of Haematology, "Hospital General Universitario de Valencia", Valencia, Spain.
Blood Transfus. 2017 Sep;15(5):472-477. doi: 10.2450/2016.0012-16. Epub 2016 Jun 24.
The incidence of alloimmunisation in myelodysplastic syndromes (MDS) during the era of supportive treatment ranges from 9 to 56%. However, it is unknown if the widespread use of hypomethylating agents has changed the risk of immunisation. The aim of this study is to evaluate the impact of azacitidine (AZA) therapy on red blood cell (RBC) alloimmunisation in transfused patients with MDS, myelodysplastic syndromes/myeloproliferative syndromes (MDS/MPS) and secondary acute myeloid leukaemia (AML).
We have analysed retrospectively all patients with MDS, MDS/MPS and secondary AML from MDS, who received their first transfusion in our hospital between January 1995 and December 2014. We have assessed the impact of age, sex, RBC and platelets units transfused, and AZA treatment on developing alloantibodies.
In our study, the number of RBC units transfused increased the risk of developing alloantibodies. However aging and the treatment with AZA were associated with a lower rate of alloimmunisation.
Patients with MDS, MDS/MPS and secondary AML who received treatment with AZA developed RBC antibodies at a lower rate than control group. We suggest that aging and immunosuppression due to AZA therapy could develop an immunological tolerance with a weak response to allotransfusions.
在支持治疗时代，骨髓增生异常综合征（MDS）的同种免疫发生率为 9%至 56%。然而，目前尚不清楚广泛使用低甲基化药物是否改变了免疫的风险。本研究旨在评估阿扎胞苷（AZA）治疗对输血 MDS、骨髓增生异常综合征/骨髓增生性综合征（MDS/MPS）和继发性急性髓系白血病（AML）患者 RBC 同种免疫的影响。
我们回顾性分析了 1995 年 1 月至 2014 年 12 月期间在我院首次输血的 MDS、MDS/MPS 和继发性 AML 患者。我们评估了年龄、性别、RBC 和血小板单位输血以及 AZA 治疗对产生同种抗体的影响。
在我们的研究中，RBC 单位输血的数量增加了产生同种抗体的风险。然而，年龄和 AZA 治疗与较低的同种免疫率相关。
接受 AZA 治疗的 MDS、MDS/MPS 和继发性 AML 患者产生 RBC 抗体的比率低于对照组。我们认为，AZA 治疗引起的衰老和免疫抑制可能导致对同种异体输血的免疫耐受和弱反应。
