10) The BCSH cited the fact that there are few reports of TA-GVHD in preterm and full-term infants (10); however, this does not appear to take into account the potential for developing TA-GVHD if a condition that would put the infant at risk has yet to be diagnosed.
Based on multiple documented cases of TA-GVHD in this population, the European School of Haematology, the European Group for Blood and Marrow Transplantation, the Foundation for the Accreditation of Cellular Therapy, and the BCSH Blood Transfusion Task Force all recommend irradiated blood products for allogeneic and autologous hematopoietic progenitor cell recipients.
Regarding non-Hodgkin lymphoma, the 2011 BCSH Blood Transfusion Task Force states, "There are relatively few reports of TA-GVHD in non-Hodgkin lymphoma (NHL) and the majority have been in patients with high-grade disease.
Granulocyte transfusions, which are given to neutropenic patients within 24 hours of collection and contain lymphocytes and have been identified as a potential cause of TA-GVHD, were only irradiated per policy in 995 of 2066 organizations (48.
10) Other therapies not included in the AABB survey that have also been identified as potential causes of TA-GVHD are treatment with purine analogue drugs (fludarabine, cladribine, and deoxycoformycin) as well as alemtuzumab (an anti-CD52 agent) and ATG.
Curiously, the converse was true for patients with solid organ tumors, where the percentage of those providing irradiated cellular blood product for the prevention of TA-GVHD nearly doubled, from 95 of 474 (20.
Whereas this represents potential progress in irradiation practices (particularly in the case of Hodgkin disease), irradiation of cellular blood product for the prevention of TA-GVHD would appear to remain underused in other groups well documented to be at risk for TA-GVHD.
Despite recognition of some of the underlying risks predisposing patients to TA-GVHD, rare cases of TA-GVHD continue to be reported, simply based on the chance that a random blood donor will share enough similarity in HLA type that the recipient will fail to recognize the donor lymphocytes as foreign (thus allowing them to proliferate and attack the host).
To the extent that this is the case, respondents' lack of familiarity with their own institutions' indications for irradiation of cellular blood products cannot be excluded as contributors to the unexpectedly low rates of irradiation for conditions or circumstances widely thought to put patients at risk for developing TA-GVHD.
Intriguingly, despite the high fatality rate associated with the development of TA-GVHD and findings that would appear to reflect that irradiation of cellular blood products is less than uniform for at-risk populations, there are relatively few recent reports of deaths attributed to TA-GVHD in the United States.