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Abstract
Incidence of Red Blood Cell Alloimmunisation in Transfused Myelodysplastic Syndromes Patients: A Systematic Review and Meta-Analysis
Vera Abba and Denise E. Jackson*
Background: Red Blood Cell (RBC) alloimmunisation represents a major complication in transfused Myelodysplastic Syndrome (MDS) patients. Frequent transfusion dependency increases the risk of alloantibody formation, while Hypomethylating Agent (HMA) therapy may have immunomodulatory effects that influence this outcome. This meta-analysis aimed to evaluate the incidence of RBC alloimmunisation in transfused MDS patients and assess the impact of HMA therapy.
Methods: A systematic review and meta-analysis was conducted according to PRISMA guidelines. Relevant studies were identified through PubMed, Scopus, Embase, and Google Scholar databases. Study quality was assessed using the STROBE checklist. Pooled Odds Ratios (ORs) with 95% Confidence Intervals (CIs) were calculated for alloimmunisation outcomes using a random-effects model in RevMan 5.4.1.
Results: Seven studies published between 2001 and 2024 met the inclusion criteria. The pooled analysis demonstrated a significantly higher risk of RBC alloimmunisation in transfused MDS patients compared with non-MDS controls (OR=1.68; 95% CI 1.13-2.51; P=0.01). A higher transfusion burden was associated with an even greater risk (OR=3.43; 95% CI 1.83-6.43; P=0.0001). HMA-treated MDS patients showed a lower risk compared with untreated controls, though this trend did not reach statistical significance (OR=0.42; 95% CI 0.17-1.03; P=0.06).
Conclusion: Transfused MDS patients are at increased risk of RBC alloimmunisation, particularly with higher transfusion exposure. Although not statistically significant, HMA therapy showed a trend toward reducing alloimmunisation, suggesting a potential immunomodulatory effect that requires further investigation. These findings may inform transfusion strategies and guide future research.
Published Date: 2025-12-22; Received Date: 2025-11-20