• About Us
    • Contact Us
    • Login
    • ObGFirst
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • COVID-19
About Us Contact Us Login ObGFirst
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • COVID-19
Grand Rounds

Recurrent Miscarriage: Does Lymphocyte Immunotherapy Improve Pregnancy Outcomes?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • Immunological mechanisms may be one possible cause of recurrent miscarriage
    • Paternal lymphocyte immunotherapy (LIT) is one proposed treatment option
  • Sarno et al. (European Journal of Obstetrics & Gynecology and Reproductive Biology, 2019) evaluated perinatal outcomes following LIT among couples with recurrent miscarriage

METHODS:

  • Retrospective analysis
    • Multicenter, observational study from 6 REI centers
  • Participants
    • Recurrent miscarriage: defined as ≥2 spontaneous abortions before 22 weeks
    • Same partner
    • With or without previous pregnancies >20 weeks
    • No anti-paternal HLA antibodies
  • Groups: Recurrent miscarriage (all received vaginal progesterone during the first trimester)
    • Without LIT
    • With LIT
  • LIT protocol
    • 80 mL fresh blood from partner
    • WBCs separated and washed
    • 80–100 million WBCs injected intradermally
    • Immunizations repeated on three different days with 3 weeks in between
    • If patient had a positive crossmatch (had immune response), she continued in the study
    • Booster q3 months then q4weeks after positive pregnancy test
  • Immune categories
    • Category 1: Alloimmune factor positive | Category 2: Alloimmune factor and thrombophilic factor (e.g., antiphospholipid syndrome (APS) and/or other hereditary thrombophilias | Category 3: Alloimmune factor and autoimmune factor (not APS) | Category 4: Alloimmune factor associated plus ≥1 thrombophilia and ≥1 autoantibody
  • Primary outcomes
    • Gestation success | GA at birth | Preterm (<37 weeks) | Extreme preterm (<28 weeks) | Birthweight

RESULTS:

  • 1096 couples included
  • High rate of preterm deliveries
    • LIT: 24.3% | LIT: 29.9%
  • Gestation success rate was higher in the LIT group (p <  0.001)
    • LIT group: 60.1%
    • Non-LIT group: 33.1%
  • Success of gestation was significantly higher with LIT even when broken out by immune status
    • Poor prognosis regardless of LIT remained for women who were autoantibody positive (except antiphospholipids)
  • There was no significant difference for the following
    • GA at birth | Preterm | Extreme preterm | Birthweight
  • Compared to LIT only prior to pregnancy, LIT during pregnancy was associated with improved gestation success rates (p<0.001)
    • During pregnancy: 78.3%
    • Before pregnancy: 34.1%

CONCLUSION:

  • LIT before and/or during pregnancy may increase success of gestation for some couples with recurrent miscarriage
  • Success may depend on immune group status
  • Maintenance of LIT during pregnancy appears to be important for success, even if there is evidence of successful reaction to LIT prior to pregnancy

Learn More – Primary Sources:

Gestational and perinatal outcomes in recurrent miscarriages couples treated with lymphocyte immunotherapy

Now You Can Get ObG Clinical Research Summaries Direct to Your Phone, with ObGFirst

Learn More »

image_pdfFavoriteLoadingFavorite
< Previous
All Grand Rounds Posts
Next >

Related ObG Topics:

How Effective are Treatments for Unexplained Recurrent Miscarriage?
Is Karyotyping POCs Following Recurrent Miscarriage Cost-Effective?
Practical info on evidence based medicine for your women's healthcare practice
Recurrent Miscarriage – does progesterone improve outcomes?

Sections

  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • COVID-19

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site