{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:19:04Z","timestamp":1787019544152,"version":"build-2736575974"},"reference-count":33,"publisher":"American Society of Hematology","issue":"3","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,1,21]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Platelet transfusion refractoriness results in adverse outcomes and increased health care costs. Managing refractoriness resulting from HLA alloimmunization necessitates the use of HLA antigen\u2013matched platelets but requires a large platelet donor pool and does not guarantee full matching. We report the first randomized, double-blind, noninferiority, crossover trial comparing HLA epitope\u2013matched (HEM) platelets with HLA standard antigen\u2013matched (HSM) platelet transfusions. Alloimmunized, platelet-refractory, thrombocytopenic patients with aplastic anemia, myelodysplastic syndrome, or acute myeloid leukemia were eligible. HEM platelets were selected using HLAMatchMaker epitope (specifically eplet) matching. Patients received up to 8 prophylactic HEM and HSM transfusions provided in random order. The primary outcome was 1-hour posttransfusion platelet count increment (PCI). Forty-nine patients were randomized at 14 UK hospitals. For intention to treat, numbers of evaluable transfusions were 107 and 112 for HEM and HSM methods, respectively. Unadjusted mean PCIs for HEM and HSM methods were 23.9 (standard deviation [SD], 15) and 23.5 (SD, 14.1), respectively (adjusted mean difference, \u22120.1; 95% confidence interval [CI], \u22122.9 to 2.8). Because the lower limit of the 95% CI was not greater than the predefined noninferiority limit, the HEM approach was declared noninferior to the HSM approach. There were no differences in secondary outcomes of platelet counts, transfusion requirements, and bleeding events. Adequate 1-hour PCI was more frequently observed, with a mean number of 3.2 epitope mismatches, compared with 5.5 epitope mismatches for inadequate 1-hour increments. For every additional epitope mismatch, the likelihood of an adequate PCI decreased by 15%. Epitope-matched platelets should be considered to support HLA alloimmunized patients. This trial was registered at www.isrctn.com as #ISRCTN23996532.<\/jats:p>","DOI":"10.1182\/blood.2020007199","type":"journal-article","created":{"date-parts":[[2020,10,16]],"date-time":"2020-10-16T22:01:42Z","timestamp":1602885702000},"page":"310-322","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":40,"title":["An epitope-based approach of HLA-matched platelets for transfusion: a noninferiority crossover randomized trial"],"prefix":"10.1182","volume":"137","author":[{"given":"Judith C.","family":"Marsh","sequence":"first","affiliation":[{"name":"Department of Haematological Medicine, King\u2019s College Hospital, London, United Kingdom;"},{"name":"Department of Haematology, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King\u2019s College London, London, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon J.","family":"Stanworth","sequence":"additional","affiliation":[{"name":"Transfusion Medicine, NHS Blood and Transplant (NHSBT), Oxford, United Kingdom;"},{"name":"Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom;"},{"name":"Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom;"},{"name":"NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura A.","family":"Pankhurst","sequence":"additional","affiliation":[{"name":"NHSBT Clinical Trials Unit, Cambridge, United Kingdom;"},{"name":"NHSBT Clinical Trials Unit, Bristol, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delordson","family":"Kallon","sequence":"additional","affiliation":[{"name":"Haematology, Barts and The London Hospital, London, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adeline Z.","family":"Gilbertson","sequence":"additional","affiliation":[{"name":"H&I Laboratory, NHSBT, Colindale, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Collette","family":"Pigden","sequence":"additional","affiliation":[{"name":"Department of Haematological Medicine, King\u2019s College Hospital, London, United Kingdom;"},{"name":"Department of Haematology, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King\u2019s College London, London, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8351-4186","authenticated-orcid":false,"given":"Alison J.","family":"Deary","sequence":"additional","affiliation":[{"name":"NHSBT Clinical Trials Unit, Cambridge, United Kingdom;"},{"name":"NHSBT Clinical Trials Unit, Bristol, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana S.","family":"Mora","sequence":"additional","affiliation":[{"name":"NHSBT Clinical Trials Unit, Cambridge, United Kingdom;"},{"name":"NHSBT Clinical Trials Unit, Bristol, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Brown","sequence":"additional","affiliation":[{"name":"NHSBT Clinical Trials Unit, Cambridge, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8309-0990","authenticated-orcid":false,"given":"Emma S.","family":"Laing","sequence":"additional","affiliation":[{"name":"NHSBT Clinical Trials Unit, Cambridge, United Kingdom;"},{"name":"NHSBT Clinical Trials Unit, Bristol, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise L.","family":"Choo","sequence":"additional","affiliation":[{"name":"MRC Clinical Trials Unit, University College London, London, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renate","family":"Hodge","sequence":"additional","affiliation":[{"name":"NHSBT Clinical Trials Unit, Cambridge, United Kingdom;"},{"name":"NHSBT Clinical Trials Unit, Bristol, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte A.","family":"Llewelyn","sequence":"additional","affiliation":[{"name":"NHSBT Clinical Trials Unit, Cambridge, United Kingdom;"},{"name":"NHSBT Clinical Trials Unit, Bristol, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kay","family":"Harding","sequence":"additional","affiliation":[{"name":"NHSBT Clinical Trials Unit, Cambridge, United Kingdom;"},{"name":"NHSBT Clinical Trials Unit, Bristol, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Sage","sequence":"additional","affiliation":[{"name":"Histocompatibility and Immunogenetics (H&I) Laboratory, NHSBT, Tooting, United Kingdom; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandar","family":"Mijovic","sequence":"additional","affiliation":[{"name":"Department of Haematological Medicine, King\u2019s College Hospital, London, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghulam J.","family":"Mufti","sequence":"additional","affiliation":[{"name":"Department of Haematological Medicine, King\u2019s College Hospital, London, United Kingdom;"},{"name":"Department of Haematology, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King\u2019s College London, London, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina V.","family":"Navarrete","sequence":"additional","affiliation":[{"name":"H&I Laboratory, NHSBT, Colindale, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5678-2799","authenticated-orcid":false,"given":"Colin J.","family":"Brown","sequence":"additional","affiliation":[{"name":"H&I Laboratory, NHSBT, Colindale, United Kingdom;"},{"name":"Faculty of Life Sciences and Medicine, King\u2019s College London, University of London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"234","reference":[{"issue":"3","key":"2021012116214118300_B1","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1038\/sj.bmt.1702490","article-title":"Bleeding risk and platelet transfusion refractoriness in patients with acute myelogenous leukemia who undergo autologous stem cell transplantation","volume":"26","author":"Toor","year":"2000","journal-title":"Bone Marrow Transplant"},{"issue":"4","key":"2021012116214118300_B2","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1111\/j.1399-0039.2012.01852.x","article-title":"HLA alloimmunization against platelet transfusions: pathophysiology, significance, prevention and management","volume":"79","author":"Pavenski","year":"2012","journal-title":"Tissue Antigens"},{"issue":"4","key":"2021012116214118300_B3","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1007\/s002770050280","article-title":"Frequency and causes of refractoriness in multiply transfused patients","volume":"74","author":"Legler","year":"1997","journal-title":"Ann Hematol"},{"issue":"26","key":"2021012116214118300_B4","doi-asserted-by":"crossref","first-page":"1861","DOI":"10.1056\/NEJM199712253372601","article-title":"Leukocyte reduction and ultraviolet B irradiation of platelets to prevent alloimmunization and refractoriness to platelet transfusions","volume":"337","author":"Trial to Reduce Alloimmunization to Platelets Study Group","year":"1997","journal-title":"N Engl J Med"},{"issue":"1","key":"2021012116214118300_B5","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1182\/blood-2003-03-0940","article-title":"Universal prestorage leukoreduction in Canada decreases platelet alloimmunization and refractoriness","volume":"103","author":"Seftel","year":"2004","journal-title":"Blood"},{"issue":"3","key":"2021012116214118300_B6","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1046\/j.1365-2141.1997.812721.x","article-title":"Pilot study of HLA alloimmunization after transfusion with pre-storage leucodepleted blood products in aplastic anaemia","volume":"97","author":"Killick","year":"1997","journal-title":"Br J Haematol"},{"issue":"12","key":"2021012116214118300_B7","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.3324\/haematol.2009.010231","article-title":"Granulocyte transfusions in severe aplastic anemia: an eleven-year experience","volume":"94","author":"Quillen","year":"2009","journal-title":"Haematologica"},{"issue":"4","key":"2021012116214118300_B8","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1002\/1096-8652(200008)64:4<251::AID-AJH3>3.0.CO;2-N","article-title":"Platelet transfusions: utilization and associated costs in a tertiary care hospital","volume":"64","author":"Meehan","year":"2000","journal-title":"Am J Hematol"},{"issue":"2","key":"2021012116214118300_B9","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1111\/j.1423-0410.2011.01474.x","article-title":"Clinical relevance of the HLA system in blood transfusion","volume":"101","author":"Brown","year":"2011","journal-title":"Vox Sang"},{"issue":"12","key":"2021012116214118300_B10","doi-asserted-by":"crossref","first-page":"1446","DOI":"10.1046\/j.1537-2995.2000.40121446.x","article-title":"Selecting donors of platelets for refractory patients on the basis of HLA antibody specificity","volume":"40","author":"Petz","year":"2000","journal-title":"Transfusion"},{"issue":"5","key":"2021012116214118300_B11","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1182\/blood.V51.5.781.781","article-title":"Platelet transfusion therapy. 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