Prevention of Transfusion-Associated Graft-Versus-Host Disease (TA-GVHD)

Summary of Amendments

• Changes from 2011 guidelines

  This edition has undergone a major revision. These changes include:

  • Options for implementation of TA-GVHD prophylaxis through universal irradiation immediately prior to red cell issue (section 4.2) or using traditional risk assessment based approach (section 4.3).
  • Inclusion of guideline development method (section 1.3)
  • Inclusion / update on the treatments of cellular products to reduce the risk of TA-GVHD,
    including:
    o X-ray irradiation (section 3.3),
    o pathogen reduction technologies (section 3.4),
    o leucocycte depletion (section 3.5),
    o cold storage duration of red cells (section 3.6).
  • Inclusion of older cold stored red cells as irradiation equivalent or irradiation safe based on storage duration and minimal to no ability to cause TA-GVHD (section 4.4).
  • More specific advice on patient selection in neonates and children (section 5.2)
  • Additional advice on assessment for severe immunodeficiency in children (section 5.2)
  • Specific advice for emergency transfusions (section 5.9), including in paediatric practice (section 5.2)
  • Inclusion of new indications:
    o Chemotherapy equivalent to acute lymphoblastic leukaemia (ALL) or acute myeloid leukaemia (AML) induction (section 5.3)
    o Irradiation of blood products to extend to six months post infusion for chimeric antigen receptor (CAR)-T cell or autologous stem cell recipients or (section 5.3)
    o Acute radiation injury
  • Removal of indications:
    o Lower dose alemtuzumab (used for solid organ transplantation, multiple sclerosis or similar indications)
  • Possible indications have been removed from the guidelines. Clinicians are encouraged to use a risk based assessment when the risk of irradiation is uncertain. Non-Hodgkin lymphoma (including T and B cell malignancies), acute leukaemia (section 5.3), term neonates (section 5.2), long term steroid therapy (section 5.5) and aplastic anaemia (section 5.3) have been discussed in relevant sections as many patients in these groups will require irradiation, although the conditions are not in themselves indications. Patient receiving chemotherapy has been modified to therapy of similar intensity to acute leukaemia induction. Massive transfusion for trauma is no longer considered a possible indication, based on new data (section 6.1).