April 5th, 2020

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Immunotherapy with Paternal Lymphocytes for Patients with Unexplained Recurrent Abortion and Association with Blocking Antibodies: Comparison Between Patient Groups with Primary and Secondary Unexplained Recurrent Abortion
Authors:  Taro Nonaka, M.D., Marie Tominaga, M.D., Makiko Takahashi, M.D., Chika Nonaka, M.D., Takayuki Enomoto, M.D., and Koichi Takakuwa, M.D.
  OBJECTIVE: To evaluate the efficacy of immunotherapy for patients with primary and secondary unexplained recurrent abortion (URA) using paternal lymphocytes.

STUDY DESIGN: A total of 308 patients with primary URA and 101 with secondary URA were analyzed. Immunotherapy was adopted for patients negative for mixed lymphocyte culture reaction–blocking antibodies (MLR-BAbs). The efficacy of immunotherapy was analyzed for both primary and secondary URA groups.

RESULTS: The positive rate of MLR-BAbs in primary URA was significantly lower as compared with that in secondary URA. The success rate with immunotherapy was significantly higher as compared with that in nonimmunized patients (eligible for immunotherapy) for primary URA (78.6% vs. 30.4%, respectively, p<0.00001) and secondary URA (82.1% vs. 23.1%, respectively, p<0.005). Moreover, the success rate with immunotherapy was significantly higher as compared with that in noneligible patients (positive for MLR-BAbs) for the primary URA group. Analyses of the live birth rate by intention-to-treat (LBR-ITT) also revealed the efficacy of immunotherapy, in which LBR-ITT in the immunized group was significantly higher as compared with that in the noneligible group for secondary URA.

CONCLUSION: Immunotherapy for patients with URA negative for MLR-BAbs is considered to be effective for both groups, and the URA group positive for MLR-BAbs might benefit from the immunotherapy.
Keywords:  abortion, habitual; abortion, recurrent; alloimmunity; assisted reproductive techniques; immunotherapy; miscarriage, recurrent; mixed lymphocyte culture reaction; paternal lymphocytes; recurrent abortion; recurrent early pregnancy loss; unexplained recurrent abortion
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