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

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