Current and potential immunosuppressive treatments to avoid alloimmunization
| Currently used in transfusion . | Mechanism of action . | Transfusion (in vitro studies and mouse models) . | Indications in transfusion . |
|---|---|---|---|
| Rituximab | Anti-CD20 Targets B cells | Prevention of erythrocyte alloimmunization32 | Prevention of immunization in patients at risk and for additional transfusion in active DHTR patients |
| Bortezomib | Proteasome inhibitor Targets metabolically active cells including plasma cells | Prevention of erythrocyte alloimmunization33 | Prevention of immunization in patients at risk and for additional transfusion in active DHTR patients |
| IVIG | Immune complexes | Treatment of immune erythrocyte hemolysis40 | |
| Corticosteroids | Anti-inflammatory | Treatment of immune erythrocyte hemolysis40 | |
| Potentially useful in transfusion | Current indications in medicine | ||
| Belatacept | CTLA4-Ig Targets CD80 and CD86. Inhibition of Tfh-dependent antibody response through CD28 costimulation blockade | Prevention of platelet alloimmunization34 | Kidney transplantation |
| Belimumab | Anti-BAFF Targets B cell | No studies in transfusion | Lupus |
| Daratumumab | Anti-CD38 Targets plasma cells | No studies in transfusion | Multiple myeloma |
| Tofacitinib | JAK inhibitor Targets JAK family of kinases involved in proinflammatory cytokine production and cytokine receptor activation | No studies in transfusion | Rheumatoid arthritis |
| Quinine | Small heme binding molecule Targets heme derivatives; in B cells, upregulates heme oxygenase 1 and inhibits B-cell maturation | Prevention of erythrocyte alloimmunization35,36 | Malaria |
| Currently used in transfusion . | Mechanism of action . | Transfusion (in vitro studies and mouse models) . | Indications in transfusion . |
|---|---|---|---|
| Rituximab | Anti-CD20 Targets B cells | Prevention of erythrocyte alloimmunization32 | Prevention of immunization in patients at risk and for additional transfusion in active DHTR patients |
| Bortezomib | Proteasome inhibitor Targets metabolically active cells including plasma cells | Prevention of erythrocyte alloimmunization33 | Prevention of immunization in patients at risk and for additional transfusion in active DHTR patients |
| IVIG | Immune complexes | Treatment of immune erythrocyte hemolysis40 | |
| Corticosteroids | Anti-inflammatory | Treatment of immune erythrocyte hemolysis40 | |
| Potentially useful in transfusion | Current indications in medicine | ||
| Belatacept | CTLA4-Ig Targets CD80 and CD86. Inhibition of Tfh-dependent antibody response through CD28 costimulation blockade | Prevention of platelet alloimmunization34 | Kidney transplantation |
| Belimumab | Anti-BAFF Targets B cell | No studies in transfusion | Lupus |
| Daratumumab | Anti-CD38 Targets plasma cells | No studies in transfusion | Multiple myeloma |
| Tofacitinib | JAK inhibitor Targets JAK family of kinases involved in proinflammatory cytokine production and cytokine receptor activation | No studies in transfusion | Rheumatoid arthritis |
| Quinine | Small heme binding molecule Targets heme derivatives; in B cells, upregulates heme oxygenase 1 and inhibits B-cell maturation | Prevention of erythrocyte alloimmunization35,36 | Malaria |