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risks of homologous blood transfusion, such a study is unethical. Less controversial would be randomization of patients likely to be transfused into an autologous blood program. A study utilizing multiple institutions in the Netherlands with over 500 colorectal cancer patients (23) found the relative risk of cancer recurrence for patients transfused with 1 -2 units of autologous blood was 1.78 compared to untransfused patients and 2.11 for recipients of 1 - 2 units of homologous blood. Both autologous and homologous transfusions were bufify coat poor, standard for the Netherlands. Blood transfusion, whether autologous or homologous, was associated with significantly increased risk of cancer recurrence but the risk for both groups was comparable. A randomized prospective study of colorectal cancer patients by Weiss et al., (34) from Munich randomized 120 patients to receive either homologous or autologous blood if transfusion were needed. With median follow-up of 21 months (9 - 48), the recurrence rate among homologous recipients is 29% compared to 17% among autologous recipients and was significant in both B (p = 0.032) and C (p = 0.006) tumors. Multivariate regression identified homologous blood as an independent prognostic factor (p = 0.008). EXPERIMENTAL STUDIES OF TRANSFUSION AND TUMOR GROWTH Experimental studies control for tumor burden (disease stage) and extent of the procedure including blood loss. Allogeneic blood transfusion produces profound changes in the immune systems of experimental animals which are analogous to those observed in man. Experimental studies have observed promotion or inhibition of tumor growth following allogeneic blood transfusions because the effect of transfusion on tumor growth is route-, tumor-, species-, and strain-specific. In mice, tail vein inoculation of basal call carcinoma produces pulmonary nodules which are inhibited by prior allogeneic transfusion while no effect is seen if the tumor is given subcutaneously (35). In the same strain, growth of subcutaneous adenocarcinoma is inhibited by transfusion while pulmonary nodules are unaffected. Timing of transfusion relative to tumor inoculation also determines subsequent tumor growth. Studies of tumor growth in experimental animals lack analogy to the situation in the cancer patient. The tumor has been present for years in patients with malignancies and some immunologic interaction between the host and the tumor has preceded the effects of surgery and blood transfusion. In experimental studies, tumor inoculation generally followed allogeneic transfusion. MISCELLANEOUS PHENOMENA ASSOCIATED WITH BLOOD TRANSFUSION Recurrent Abortion One of the most exciting, intriguing and controversial areas in which transfusion affects the outcome and has a therapeutic role is in the treatment of recurrent abortion. During pregnancy, lymphocyte function, as measured by responses to antigens, mitogens and homologous lymphocytes (MLR), is suppressed. Inhibition of lymphocyte function is due to serum factors, blocking antibodies which develop in response to trophoblast antigens. When spouses share HLA antigens, trophoblast antigens are not recognized by the pregnant woman's immune system, blocking antibodies are not produced, and the fetus is rejected. In 1981 Taylor and Faulk (36) induced suppressive sera in women suffering from recurrent spontaneous abortion and sharing HLA antigens with their spouse by transfusing the women with leukocyte-enriched plasma from
DOI link for risks of homologous blood transfusion, such a study is unethical. Less controversial would be randomization of patients likely to be transfused into an autologous blood program. A study utilizing multiple institutions in the Netherlands with over 500 colorectal cancer patients (23) found the relative risk of cancer recurrence for patients transfused with 1 -2 units of autologous blood was 1.78 compared to untransfused patients and 2.11 for recipients of 1 - 2 units of homologous blood. Both autologous and homologous transfusions were bufify coat poor, standard for the Netherlands. Blood transfusion, whether autologous or homologous, was associated with significantly increased risk of cancer recurrence but the risk for both groups was comparable. A randomized prospective study of colorectal cancer patients by Weiss et al., (34) from Munich randomized 120 patients to receive either homologous or autologous blood if transfusion were needed. With median follow-up of 21 months (9 - 48), the recurrence rate among homologous recipients is 29% compared to 17% among autologous recipients and was significant in both B (p = 0.032) and C (p = 0.006) tumors. Multivariate regression identified homologous blood as an independent prognostic factor (p = 0.008). EXPERIMENTAL STUDIES OF TRANSFUSION AND TUMOR GROWTH Experimental studies control for tumor burden (disease stage) and extent of the procedure including blood loss. Allogeneic blood transfusion produces profound changes in the immune systems of experimental animals which are analogous to those observed in man. Experimental studies have observed promotion or inhibition of tumor growth following allogeneic blood transfusions because the effect of transfusion on tumor growth is route-, tumor-, species-, and strain-specific. In mice, tail vein inoculation of basal call carcinoma produces pulmonary nodules which are inhibited by prior allogeneic transfusion while no effect is seen if the tumor is given subcutaneously (35). In the same strain, growth of subcutaneous adenocarcinoma is inhibited by transfusion while pulmonary nodules are unaffected. Timing of transfusion relative to tumor inoculation also determines subsequent tumor growth. Studies of tumor growth in experimental animals lack analogy to the situation in the cancer patient. The tumor has been present for years in patients with malignancies and some immunologic interaction between the host and the tumor has preceded the effects of surgery and blood transfusion. In experimental studies, tumor inoculation generally followed allogeneic transfusion. MISCELLANEOUS PHENOMENA ASSOCIATED WITH BLOOD TRANSFUSION Recurrent Abortion One of the most exciting, intriguing and controversial areas in which transfusion affects the outcome and has a therapeutic role is in the treatment of recurrent abortion. During pregnancy, lymphocyte function, as measured by responses to antigens, mitogens and homologous lymphocytes (MLR), is suppressed. Inhibition of lymphocyte function is due to serum factors, blocking antibodies which develop in response to trophoblast antigens. When spouses share HLA antigens, trophoblast antigens are not recognized by the pregnant woman's immune system, blocking antibodies are not produced, and the fetus is rejected. In 1981 Taylor and Faulk (36) induced suppressive sera in women suffering from recurrent spontaneous abortion and sharing HLA antigens with their spouse by transfusing the women with leukocyte-enriched plasma from
risks of homologous blood transfusion, such a study is unethical. Less controversial would be randomization of patients likely to be transfused into an autologous blood program. A study utilizing multiple institutions in the Netherlands with over 500 colorectal cancer patients (23) found the relative risk of cancer recurrence for patients transfused with 1 -2 units of autologous blood was 1.78 compared to untransfused patients and 2.11 for recipients of 1 - 2 units of homologous blood. Both autologous and homologous transfusions were bufify coat poor, standard for the Netherlands. Blood transfusion, whether autologous or homologous, was associated with significantly increased risk of cancer recurrence but the risk for both groups was comparable. A randomized prospective study of colorectal cancer patients by Weiss et al., (34) from Munich randomized 120 patients to receive either homologous or autologous blood if transfusion were needed. With median follow-up of 21 months (9 - 48), the recurrence rate among homologous recipients is 29% compared to 17% among autologous recipients and was significant in both B (p = 0.032) and C (p = 0.006) tumors. Multivariate regression identified homologous blood as an independent prognostic factor (p = 0.008). EXPERIMENTAL STUDIES OF TRANSFUSION AND TUMOR GROWTH Experimental studies control for tumor burden (disease stage) and extent of the procedure including blood loss. Allogeneic blood transfusion produces profound changes in the immune systems of experimental animals which are analogous to those observed in man. Experimental studies have observed promotion or inhibition of tumor growth following allogeneic blood transfusions because the effect of transfusion on tumor growth is route-, tumor-, species-, and strain-specific. In mice, tail vein inoculation of basal call carcinoma produces pulmonary nodules which are inhibited by prior allogeneic transfusion while no effect is seen if the tumor is given subcutaneously (35). In the same strain, growth of subcutaneous adenocarcinoma is inhibited by transfusion while pulmonary nodules are unaffected. Timing of transfusion relative to tumor inoculation also determines subsequent tumor growth. Studies of tumor growth in experimental animals lack analogy to the situation in the cancer patient. The tumor has been present for years in patients with malignancies and some immunologic interaction between the host and the tumor has preceded the effects of surgery and blood transfusion. In experimental studies, tumor inoculation generally followed allogeneic transfusion. MISCELLANEOUS PHENOMENA ASSOCIATED WITH BLOOD TRANSFUSION Recurrent Abortion One of the most exciting, intriguing and controversial areas in which transfusion affects the outcome and has a therapeutic role is in the treatment of recurrent abortion. During pregnancy, lymphocyte function, as measured by responses to antigens, mitogens and homologous lymphocytes (MLR), is suppressed. Inhibition of lymphocyte function is due to serum factors, blocking antibodies which develop in response to trophoblast antigens. When spouses share HLA antigens, trophoblast antigens are not recognized by the pregnant woman's immune system, blocking antibodies are not produced, and the fetus is rejected. In 1981 Taylor and Faulk (36) induced suppressive sera in women suffering from recurrent spontaneous abortion and sharing HLA antigens with their spouse by transfusing the women with leukocyte-enriched plasma from
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