Irradiation of blood and blood components to prevent post-transfusion graft-versus-host disease in Japan

Abstract

Background/Case Studies: Post-transfusion graft-vs.-host disease (PTGVHD) was previously thought to affect only immunocompromised patients. However, it has been found that immunocompetent individuals can also develop PT-GVHD if the donor(s) has one-way matched HLA with the recipient. Japanese are known to be at higher risk of PT-GVHD, because there are few HLA haplotypes. Study Design/Methods: The Japan Society of Transfusion Medicine and Cell Therapy (JSTMCT) organized a subcommittee for the prevention of PT-GVHD, and has issued five updates for the guidelines on irradiation of blood and blood components to prevent PT-GVHD. Results/Findings: The first guidelines were issued on 1 January 1992, following the recognition that immunocompetent recipients had developed PT-GVHD after surgery. These guidelines recommended transfusion of irradiated blood for cardiac surgical patients, congenital immunodeficient recipients, newborn infants, newborn infants undergoing exchange transfusions and other immunocompromised patients. The second set of guidelines, issued on 12 May 1995, added that blood transfused for cancer surgery and blood within 72 hrs after donation should also be irradiated. The Ministry of Health and Welfare of Japan issued an urgent warning about PT-GVHD in April 1996 because some families blamed hospitals and blood centers for transfusion without blood irradiation. The subcommittee for the prevention of PT-GVHD issued a third version of the guidelines on 26 December 1996. Because JRCBC was licensed to supply irradiated blood and blood components on 6 June 1998, a fourth version of the guidelines was issued on 1 January 1999. These guidelines recommended that a wider range of blood and blood components should be irradiated compared to that indicated in other national guidelines. Since 2000, there have not been any cases definitively diagnosed as developing PT-GVHD after blood transfusions supplied by JRCBC. However, it became clear that there were more than a few institutions using non-irradiated blood based on a questionnaire survey of practices in 2007 and 2008 conducted by JSTMCT. In 2009, 417 units of non-irradiated red cell concentrate supplied by JRCBC were transfused but no unit of non-irradiated platelets concentrate was transfused. The fifth version of guidelines promoting universal irradiation of blood and blood components to ensure the prevention of PT-GVHD was issued on 1 January 2010. Conclusion: These guidelines seem to be effective in preventing the occurrence of PT-GVHD in Japan. However, the importance of prevention of PT-GVHD has been fading because of no cases of PT-GVHD reported since 2000. We have to emphasize the importance of using irradiated blood products and practice according to the guidelines.