Muthukumar Arun, Guerra-Londono Juan Jose, Cata Juan P
Department of Anesthesiology and Perioperative Medicine, The University of Texas, MD Anderson Cancer Center, USA.
Department of Anesthesiology and Perioperative Medicine, The University of Texas, MD Anderson Cancer Center, USA; Anesthesiology and Surgical Oncology Research Group, USA.
Best Pract Res Clin Anaesthesiol. 2023 Dec;37(4):495-502. doi: 10.1016/j.bpa.2023.10.004. Epub 2023 Oct 21.
Patients with cancer who receive allogeneic red blood cell transfusions are at risk of adverse reactions of varying severity. One of these reactions is immunomodulation, also known as transfusion-related immunomodulation. With the exact mechanism of transfusion related immunomodulation being unclear, storage lesions (both the cellular and cytokine component) are considered a major contributor. Leucocytes are believed to be implicated in storage lesions and immunomodulation. However, the efficacy of leucodepletion in reducing immunomodulation is controversial. The theoretical link between these three interconnected events - storage lesions, immunomodulation and cancer progression remain controversial and poorly understood. This article summarizes the available evidence on efficacy of leucodepletion, storage lesions and transfusion related immunomodulation, while rationalizing the possible association between an immunomodulation triggering transfusion 'dose' in cancer patients and subsequent cancer recurrence.
接受异体红细胞输血的癌症患者有发生不同严重程度不良反应的风险。其中一种反应是免疫调节，也称为输血相关免疫调节。由于输血相关免疫调节的确切机制尚不清楚，储存损伤（细胞和细胞因子成分）被认为是一个主要因素。白细胞被认为与储存损伤和免疫调节有关。然而，白细胞去除术在减少免疫调节方面的疗效存在争议。这三个相互关联的事件——储存损伤、免疫调节和癌症进展之间的理论联系仍然存在争议且了解甚少。本文总结了关于白细胞去除术、储存损伤和输血相关免疫调节疗效的现有证据，同时阐明了癌症患者中触发免疫调节的输血“剂量”与随后癌症复发之间可能存在的关联。
