Abstract
Classically, patients with solid and hematologic malignancies have been treated with
a combination of chemotherapy with or without a holistic targeted strategy using approved
conventional therapy. While the evidence-based use of Immunomodulatory drugs and Immune
checkpoint inhibitors (ICIs), including those targeting the PD-1, PD-L1 and CTLA-4,
have reshaped the treatment paradigm for many malignant tumors and significantly stretched
the life expectancy of patients, as for any interventional therapy, the rise in ICI
applications, was associated with the observation of more immune-related hematological
adverse events. Many of these patients require transfusion support during their treatment
in line with precision transfusion. It has been presumed that transfusion-related
immunomodulation (TRIM) and the microbiome can pose immunosuppressive effects on the
recipients. Looking to the past and beyond and translating available data into practice
in the evolving role of pharmaceutical therapy to ICI-receiving patients, we performed
a narrative review of the literature on the immune-related hematological adverse events
of ICIs, immunosuppressive mechanisms linked to blood product transfusions, as well
as the detrimental impact of transfusions and its related microbiome on the sustained
efficacy of ICIs and the patients’ survival outcomes. Recent reports are pointing
to the negative impact of transfusion on ICI response. Studies have concluded that
packed RBC [PRBC] transfusions lead to an inferior progression-free and overall survival
in patients with advanced cancer receiving ICIs, even after adjustments for other
prognostic variables. The attenuation of the effectiveness of immunotherapy likely
results from the immunosuppressive effects of PRBC transfusions. It is, therefore,
wise to look retrospectively and prospectively at the impact of transfusion on ICI
effects and adopt, in the interim, a restrictive transfusion strategy, if applicable,
for those patients.
Abbreviations:
ADAMTS13 (A Disintegrin and Metalloprotease with ThromboSpondin-1 motif, member 13), AE (Adverse events), AIHA (Autoimmune hemolytic anemia), CTLA-4 (Cytotoxic T-lymphocyte-associated protein 4), CRC (Colorectal cancer), FDA (Food and Drug Administration), GI (Gastrointestinal), HLH (Hemophagocytic lymphohistiocytosis), ICI (Immune checkpoint inhibitors), ICSR (Individual case safety report), ir (Immune-related), irAE (Immune-related adverse events), ITP (Immune thrombocytopenic Purpura), NSCLC (Non-small-cell lung cancer), PD-1 (programmed cell death receptor-1), PD-L1 (programmed cell death ligand-1), PRBC (Packed red blood cells), PRCA (Pure red cell aplasia), RC (Renal cell carcinoma), RBCs (Red blood cells), TMA (Thrombotic microangiopathy), TPE (Therapeutic plasma exchange), TRIM (Transfusion-related immune modulation), TTP (Thrombotic thrombocytopenic purpura), UC (Urothelial carcinoma), vWF (von Willebrand factor)Keywords
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Amiral J., Seghatchian J.: Autoimmune complications of COVID-19 and potential consequences for long-lasting disease syndromes Transfusion Apheresis Science December 2022[ in press].
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Published online: February 25, 2023
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