Price Thomas H, McCullough Jeffrey, Strauss Ronald G, Ness Paul M, Hamza Taye H, Harrison Ryan W, Assmann Susan F
Department of Medicine, University of Washington.
Bloodworks Northwest, Seattle, Washington.
Transfusion. 2018 May;58(5):1280-1288. doi: 10.1111/trf.14551. Epub 2018 Mar 1.
Although the subject of many previous studies, the importance of white blood cell (WBC) alloimmunization in granulocyte transfusion therapy has not been settled. In this study, we report the results of the effects of WBC antibodies in the RING (Resolving Infection in Neutropenia with Granulocytes) study, a randomized controlled trial comparing the efficacy of daily granulocyte transfusion therapy plus antimicrobials versus antimicrobials alone; the primary outcome results have been published previously.
One hundred fourteen subjects were enrolled in the study. Serum samples for WBC antibody determination were obtained from each subject at baseline and at 2 and 6 weeks. One hundred subjects had at least one antibody test result. Samples were tested for human leukocyte antigen (HLA) Class I and Class II antibodies as well as for granulocyte-specific antibodies using granulocyte agglutination and immunofluorescence techniques. All testing was performed at a central laboratory.
Baseline WBC alloimmunization was modest, depending somewhat on the assay. Seroconversion during the study was slightly higher in the granulocyte transfusion arm, but the differences were not statistically significant. There was no demonstrable effect of the presence of alloimmunization on the primary outcome (survival and microbial response at 42 days), the occurrence of transfusion reactions (either overall or pulmonary), or posttransfusion neutrophil increments.
The presence or development of WBC antibodies had no demonstrable effect on any clinical aspect of granulocyte transfusion therapy. It appears that, at least in the patient population studied, there is no evidence suggesting need for concern about recipient WBC alloimmunization when prescribing granulocyte transfusions.
尽管白细胞（WBC）同种免疫在粒细胞输注治疗中是此前多项研究的主题，但其重要性尚未定论。在本研究中，我们报告了白细胞抗体在RING（粒细胞治疗中性粒细胞减少症感染的解决）研究中的作用结果，这是一项随机对照试验，比较了每日粒细胞输注治疗联合抗菌药物与单纯抗菌药物的疗效；主要结局结果此前已发表。
114名受试者参与了该研究。在基线、2周和6周时从每位受试者获取用于白细胞抗体测定的血清样本。100名受试者至少有一项抗体检测结果。使用粒细胞凝集和免疫荧光技术对样本进行人类白细胞抗原（HLA）I类和II类抗体以及粒细胞特异性抗体检测。所有检测均在中心实验室进行。
基线时白细胞同种免疫程度适中，在一定程度上取决于检测方法。在粒细胞输注组中，研究期间的血清转化略高，但差异无统计学意义。同种免疫的存在对主要结局（42天时的生存率和微生物反应）、输血反应（总体或肺部）的发生或输血后中性粒细胞增加均无明显影响。
白细胞抗体的存在或产生对粒细胞输注治疗的任何临床方面均无明显影响。看来，至少在所研究的患者群体中，没有证据表明在开具粒细胞输注处方时需要担心受者白细胞同种免疫问题。
