European journal of neurology · 2026
Transfusion-Associated Graft-Versus-Host Disease Risk and Transfusion Requirements After Cladribine in Multiple Sclerosis: Time to Revise Irradiation Policy?
СтатьяНазвание и аннотация: Перевод в очереди
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Schmierer Klaus, Chen Frederick, Paling David
Аннотация
BACKGROUND: Irradiation of cellular blood components prevents transfusion-associated graft-versus-host disease (TA-GVHD). UK and Spanish guidance recommend lifelong irradiation for all patients treated with purine analogues, including cladribine, irrespective of indication or dose.
OBJECTIVE: To assess whether this approach is justified for people with multiple sclerosis (pwMS) receiving cladribine.
METHODS: Narrative synthesis of immunological data, hemovigilance evidence, and national European transfusion guidelines.
RESULTS: Cladribine used in pwMS induces transient lymphopenia with modest, reversible T-cell effects and preserved vaccine responsiveness. Since introduction of universal pre-storage leucocyte depletion, hemovigilance data show no reported cases of TA-GVHD in this setting. European guidance is heterogeneous, ranging from indefinite to time-limited or unspecified durations.
CONCLUSION: Current evidence does not clearly support the need for lifelong irradiation after cladribine treatment in pwMS. Time-limited or individualized approaches merit consideration.
OBJECTIVE: To assess whether this approach is justified for people with multiple sclerosis (pwMS) receiving cladribine.
METHODS: Narrative synthesis of immunological data, hemovigilance evidence, and national European transfusion guidelines.
RESULTS: Cladribine used in pwMS induces transient lymphopenia with modest, reversible T-cell effects and preserved vaccine responsiveness. Since introduction of universal pre-storage leucocyte depletion, hemovigilance data show no reported cases of TA-GVHD in this setting. European guidance is heterogeneous, ranging from indefinite to time-limited or unspecified durations.
CONCLUSION: Current evidence does not clearly support the need for lifelong irradiation after cladribine treatment in pwMS. Time-limited or individualized approaches merit consideration.