Unmodified Versus Leuko-reduced Allogeneic Red Blood Cells Transfusion in Cancer Patients

A Randomized Study of Unmodified Versus Leuko-reduced Allogeneic Red Blood Cells Transfusion During Surgery in Cancer Patients

There is evidence to suggest that red blood cell concentrate (RBC) transfusion may have immunomodulatory effects. The aim of this randomized single-center trial is to compare immune responses in patients undergoing cancer surgery and given either an unmodified RBC (UN-RBC) or a leuko-reduced RBC (LR-RBC) transfusion perioperatively.

This single-center study is conducted to compare the effect of peroperative transfusion of allogeneic unmodified RBC (UN-RBC) versus leuko-reduced RBC (RED-RBC) on recipient immunity. Patients undergoing cancer surgery are randomly assigned peroperatively to receive UN-RBC or RED-RBC. Groups are stratified for age, sex, tumor characteristics, prior transfusion and prior cancer treatment. Blood sampless are collected before anesthesia (d0) and at days 3, 7, 14 , 28 after transfusion/surgery and analyzed for complete cell blood count, lymphocyte subsets, cytokine production (IL4, IL10, IFNgamma, IL12), T-cells repertoire (TCR) analysis and detection of circulating donor cells. Main study endpoint is the influence of the treatment arm on IL4/IFNgamma ratio. The effect of transfusion type on any given biological parameters is also tested (peripheral blood mononuclear cell phenotyping (PBMC), cytokine production by stimulated PBMC, T cell repertoire analysis and microchimerism assessment).

Inclusion Criteria:

• Surgery for cancer with a transfusion during surgery risk greater than 30%
• Surgery in curative intent
• Written informed consent

Exclusion Criteria:

• contraindications to the use of allogeneic unmodified red blood cell concentrate
• any anti-RBC and/or anti-HLA and/or anti-granulocyte alloimmunization