From the Guidelines
For patients with lymphoplasmacytic lymphoma (LPL), irradiated and leukoreduced blood components are recommended for transfusion. These specially processed blood products help prevent transfusion-associated graft-versus-host disease (TA-GVHD) and reduce the risk of febrile non-hemolytic transfusion reactions. Irradiation inactivates donor T-lymphocytes that could cause TA-GVHD, while leukoreduction removes white blood cells that might trigger immune reactions or transmit cytomegalovirus, as supported by the American Society of Clinical Oncology clinical practice guideline update 1.
When transfusing red blood cells or platelets, these modifications are particularly important because LPL patients often have compromised immune systems due to their underlying disease and treatments like chemotherapy or stem cell transplantation. The use of leukoreduced blood products has been shown to decrease the incidence of alloantibody-mediated refractoriness to platelet transfusion in patients with acute myeloid leukemia (AML) receiving induction chemotherapy, and it is likely that this benefit extends to other patients with cancer, including those with LPL 1.
Additionally, for patients with IgM paraprotein (Waldenström's macroglobulinemia), warming blood products to 37°C may be necessary to prevent symptoms related to cold agglutinin activity. Clinicians should also be aware that some LPL patients may require special consideration for cytomegalovirus (CMV) negative products depending on their CMV status and treatment protocol, as noted in the guidelines for the use of blood components and their alternatives 1. The importance of irradiation in preventing TA-GVHD is further emphasized in the context of patients with severe immunosuppression, such as those with Hodgkin’s lymphoma or those receiving markedly immunosuppressive therapy 1.
Key considerations for transfusion in LPL patients include:
- The use of irradiated blood components to prevent TA-GVHD
- Leukoreduction to reduce the risk of febrile non-hemolytic transfusion reactions and transmission of cytomegalovirus
- Special consideration for CMV negative products based on the patient's CMV status and treatment protocol
- Warming of blood products for patients with IgM paraprotein to prevent cold agglutinin activity.
From the Research
Blood Components for Transfusion in Lymphoplasmacytic Lymphoma (LPL)
- Leukoreduced blood components are recommended for transfusion in patients with lymphoplasmacytic lymphoma (LPL) to minimize the risk of febrile nonhemolytic transfusion reactions, HLA alloimmunization, and transmission of leukotropic viruses such as EBV and CMV 2.
- The use of leukoreduced blood components can help prevent alloimmunization and associated risks in patients with LPL who require multiple transfusions 2.
- Leukoreduction can be achieved with the help of 3rd and 4th generation leukofilters, both in laboratory and patient bedside, and state of the art apheresis devices 2.
Prevention of Transfusion-Associated Graft-Versus-Host Disease (TA-GVHD)
- TA-GVHD is a rare but devastating disease that can be prevented by irradiation of all cellular blood products (red blood cells, granulocytes, and platelets) 3, 4.
- Leukoreduction alone may not be sufficient to prevent TA-GVHD, and irradiation of blood products is still recommended 4, 5.
- Double-filtered leukoreduction has been proposed as a method for risk reduction of TA-GVHD, with residual leukocyte levels below detection limits 6.
Recommended Blood Components for Transfusion
- Leukoreduced red blood cells and platelets are recommended for transfusion in patients with LPL to minimize the risk of febrile nonhemolytic transfusion reactions and HLA alloimmunization 2.
- Irradiated blood products are recommended for transfusion in patients with LPL who are at high risk of TA-GVHD, such as those with immunosuppression or who have received blood from a donor who is homozygous at a particular HLA locus 3, 5.