Clinical effectiveness of leucoreduced, pooled donor platelet concentrates, stored in plasma or additive solution with and without pathogen reduction

• Published in: British journal of haematology Vol. 150; no. 2; pp. 209 - 217
• Main Authors: Kerkhoffs, Jean‐Louis H., Van Putten, Wim L. J., Novotny, Viera M. J., Te Boekhorst, Peter A.W., Schipperus, Martin R., Zwaginga, Jaap Jan, Van Pampus, Lizzy C. M., De Greef, Georgine E., Luten, Marleen, Huijgens, Peter C., Brand, Anneke, Van Rhenen, Dick J.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-07-2010; Blackwell
• Subjects: Adult; Aged; amotosalen/UVA pathogen reduction; Bacterial Infections - prevention & control; Bacterial Infections - transmission; Biological and medical sciences; Blood Platelets - microbiology; Blood Preservation - methods; buffy‐coat; efficacy; Female; Furocoumarins; Hematologic and hematopoietic diseases; Hemorrhage - etiology; Humans; Leukocyte Reduction Procedures - methods; Male; Medical sciences; Middle Aged; Plasma; platelet; Platelet Transfusion - adverse effects; Platelet Transfusion - methods; Thrombocytopenia - therapy; Treatment Outcome; Ultraviolet Rays; Virus Diseases - prevention & control; Virus Diseases - transmission; Amotosalen; UVA radiation; Hematology; Treatment efficiency; efficacy; Blood plasma; amotosalen/UVA pathogen reduction; Additive; Platelet; Donor; Pathogenic; Concentrate; buffy-coat
• ISSN: 0007-1048; 1365-2141
• DOI: 10.1111/j.1365-2141.2010.08227.x

Summary
Pathogen reduction (PR) of platelet products increases costs and available clinical studies are equivocal with respect to clinical and haemostatic effectiveness. We conducted a multicentre, open‐label, randomized, non‐inferiority trial comparing the clinical effectiveness of buffy‐coat derived leucoreduced platelet concentrates (PC) stored for up to 7 d in plasma with platelets stored in platelet additive solution III (PASIII) without and with treatment with amotosalen‐HCl/ultraviolet‐A (UVA) photochemical pathogen reduction (PR‐PASIII). Primary endpoint of the study was 1‐h corrected count increment (CCI). Secondary endpoints were 24‐h CCI, bleeding, transfusion requirement of red cells and PC, platelet transfusion interval and adverse transfusion reactions. Compared to plasma‐PC, in the intention to treat analysis of 278 evaluable patients the mean difference for the 1‐h CCI of PR‐PASIII‐PC and PASIII‐PC was −31% (P < 0·0001) and −9% (P = n.s.), respectively. Twenty‐seven patients (32%) had bleeding events in the PR‐PASIII arm, as compared to 19 (19%) in the plasma arm and 14 (15%) in the PASIII arm (P = 0·034). Despite the potential advantages of pathogen (and leucocyte) inactivation of amotosalen‐HCl/UVA‐treated platelet products, their clinical efficacy is inferior to platelets stored in plasma, warranting a critical reappraisal of employing this technique for clinical use.