Francisco Phorenice D, Tan-Lim Carol Stephanie C, Agcaoili-De Jesus Maria Socorro L
Division of Allergy and Immunology, Department of Medicine, University of the Philippines - Philippine General Hospital, Manila, Philippines.
Division of Allergy and Immunology, Department of Pediatrics, University of the Philippines - Philippine General Hospital, Manila, Philippines.
Am J Reprod Immunol. 2022 Oct;88(4):e13605. doi: 10.1111/aji.13605. Epub 2022 Aug 2.
The efficacy of lymphocyte immunotherapy (LIT) in the treatment of recurrent pregnancy loss (RPL) from alloimmunity has been debated for years. There is conflicting evidence on the therapeutic role of LIT, since the etiology of most cases of RPL is previously classified as idiopathic.
A systematic search of PubMed and Cochrane databases was done for randomized controlled trials that assessed the efficacy of paternal lymphocyte or third donor LIT among patients with primary or secondary RPL. The primary outcome was live birth rate after LIT. Random-effect meta-analysis was conducted using the software RevMan 5.4. Pre-planned subgroup analyses of source of lymphocytes, timing and frequency of administration, and concentration per immunization dose were conducted.
Data from eight trials showed a statistically significant benefit of LIT (RR = 1.45, 95% CI 1.05-2.01). The overall live birth rate is higher in the treatment group (65.6%) compared to placebo or no treatment (45.2%). Subgroup analysis based on source of lymphocytes revealed a trend towards benefit with paternal LIT but with wide confidence interval (RR = 1.34, 95% CI = .84-2.14). Multiple doses of immunotherapy before pregnancy and low dose (5×10 cells) LIT showed significant benefit. Sensitivity analysis involving studies with a low risk of bias demonstrated significant benefit of increased live birth rate among patients treated with LIT compared to those who received placebo or no treatment (RR = 1.97, 95% CI = 1.53-2.53).
LIT demonstrate benefit in improving pregnancy outcome of patients with RPL from alloimmunity.
淋巴细胞免疫疗法（LIT）在治疗同种免疫性复发性流产（RPL）中的疗效多年来一直存在争议。由于大多数RPL病例的病因以前被归类为特发性，关于LIT治疗作用的证据相互矛盾。
对PubMed和Cochrane数据库进行系统检索，以查找评估父系淋巴细胞或第三方供体LIT在原发性或继发性RPL患者中的疗效的随机对照试验。主要结局是LIT后的活产率。使用RevMan 5.4软件进行随机效应荟萃分析。对淋巴细胞来源、给药时间和频率以及每次免疫剂量的浓度进行了预先计划的亚组分析。
八项试验的数据显示LIT具有统计学上的显著益处（RR = 1.45，95% CI 1.05 - 2.01）。与安慰剂或未治疗组（45.2%）相比，治疗组的总体活产率更高（65.6%）。基于淋巴细胞来源的亚组分析显示，父系LIT有获益趋势，但置信区间较宽（RR = 1.34，95% CI = 0.84 - 2.14）。妊娠前多次免疫治疗和低剂量（5×10⁶细胞）LIT显示出显著益处。涉及低偏倚风险研究的敏感性分析表明，与接受安慰剂或未治疗的患者相比，接受LIT治疗的患者活产率增加具有显著益处（RR = 1.97，95% CI = 1.53 - 2.53）。
LIT在改善同种免疫性RPL患者的妊娠结局方面显示出益处。
