My doctor is immunizing my wife with my white blood cells. He says this will keep her immune system from attacking the fetus. What can you tell me about this procedure? How does it work, and when should it be used?

Rick

White-blood-cell immunization (also called lymphocyte immune transfusion, or LIT) has been around for many years. It was first recommended as a treatment for recurrent pregnancy loss when "immunologic mismatch" is suspected between the father and the mother. Yet this approach is still controversial. Many questions remain unanswered. What conditions will LIT benefit? Are there conditions other than recurrent pregnancy loss for which LIT may be useful? Which tests indicate which patients will most likely benefit from LIT? How can the response to therapy be monitored? How long will the benefit last? What are the risks of LIT?

One large multicenter study looked at use of LIT in couples with recurrent pregnancy loss. While it appeared that women who underwent LIT were more likely to carry to term, this benefit only affected women who had already lost three or more pregnancies and had no live births. Other women saw no benefit. Unfortunately, this study did not randomize the patients into treatment or non-treatment control groups. The results of this type of study are questionable.

A more recent study attempted to answer these questions by randomizing patients into two groups; members of one group received the real treatment, while the others underwent a sham treatment that had no effect, for comparison purposes. Unfortunately, the study included women with miscarriages due to chromosomal anomalies which would not be amenable to immunotherapy. This error is study design led the investigators to prematurely conclude that LIT was of no value. They terminated the study before they gathered enough data on a large enough sample of appropriately chosen women to provide a meaningful answer. So we are still waiting for the definitive study on LIT.

Who should receive LIT? At present there are little data to suggest any benefit in conditions other than recurrent pregnancy loss. Testing for leukocyte antibody detection (LAD) or blocking antibody seems to be the test most reproductive immunologists use to determine if you may benefit from LIT.

At present, I conclude that LIT may benefit a select group of women with recurrent pregnancy loss. I am not convinced that data support its use for any other condition. Although LIT has been safely performed for many years, it must still be considered experimental therapy in terms of its ability to promote successful pregnancy outcome. More research on larger groups is needed to confirm the benefit of this treatment.