ArticleEuropean journal of neurology2026
Transfusion-Associated Graft-Versus-Host Disease Risk and Transfusion Requirements After Cladribine in Multiple Sclerosis: Time to Revise Irradiation Policy?
Article in European journal of neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIrradiation 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.
objectiveTo assess whether this approach is justified for people with multiple sclerosis (pwMS) receiving cladribine.
methodsNarrative synthesis of immunological data, hemovigilance evidence, and national European transfusion guidelines.
resultsCladribine 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.
conclusionCurrent evidence does not clearly support the need for lifelong irradiation after cladribine treatment in pwMS. Time-limited or individualized approaches merit consideration.
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