1.
Pre-transplant red blood cell and platelet transfusion burden in de novo myelodysplastic syndrome undergoing allogeneic transplantation: Pre-transplant red blood cell and platelet transfusion burden in de novo MDS after allogeneic transplantation
Konuma, T., Aoki, J., Ozawa, Y., Uchida, N., Kobayashi, T., Onizuka, M., Katayama, Y., Ohta, T., Nakano, N., Ota, S., et al
Transplantation and cellular therapy. 2021
Abstract
BACKGROUND Most patients of myelodysplastic syndrome (MDS) require red blood cell (RBC) and/or platelet transfusion during their disease courses, which could cause an increased risk of iron overload and alloimmunization. However, it remains less clear whether pre-transplant RBC or platelet transfusion burden affects transplant outcomes in patients with MDS. OBJECTIVE The objective was to examine the significance of pre-transplant RBC and platelet transfusion burden on transplant outcomes after allogeneic HCT for adults with de novo MDS. STUDY DESIGN We retrospectively evaluated the effect of pre-transplant RBC or platelet transfusion burden on transplant outcomes in a cohort of 1007 adult patients with de novo MDS treated by upfront allogeneic hematopoietic cell transplantation (HCT) between 2006 and 2018. RESULTS Both higher pre-transplant RBC and platelet transfusion burdens were significantly associated with higher overall mortality and relapse-related mortality, but not non-relapse mortality in the multivariate analysis. Higher pre-transplant RBC transfusion burden was also significantly associated with lower neutrophil, platelet, and reticulocyte recovery in the multivariate analysis. CONCLUSION In summary, our study clearly demonstrated that a higher pre-transplant RBC and platelet transfusion burden was independently associated with higher overall mortality, relapse-related mortality, and lower hematopoietic recovery after allogeneic HCT for de novo MDS. Early allogeneic HCT should be considered for patients with de novo MDS who require RBC and platelet transfusion repeatedly.
2.
A prospective non-interventional study on the impact of transfusion burden and related iron toxicity on outcome in myelodysplastic syndromes undergoing allogeneic hematopoietic cell transplantation()
Cremers, E. M. P., de Witte, T., de Wreede, L., Eikema, D. J., Koster, L., van Biezen, A., Finke, J., Socie, G., Beelen, D., Maertens, J., et al
Leukemia & lymphoma. 2019;:1-10
Abstract
Most myelodysplastic syndromes (MDS)-patients receive multiple red blood cell transfusions (RBCT). Transfusions may cause iron-related toxicity and mortality, influencing outcome after allogeneic HSCT. This prospective non-interventional study evaluated 222 MDS and CMML patients undergoing HSCT. Overall survival (OS), relapse-free survival (RFS), non-relapse mortality (NRM), and relapse incidence (RI) at 36 months were 52%, 44%, 25%, and 31%, respectively. Age, percentage of marrow blasts and severe comorbidities impacted OS. RFS was significantly associated with RBCT burden prior to HSCT (HR: 1.7; p = .02). High ferritin levels had a significant negative impact on OS and RI, but no impact on NRM. Administration of iron chelation therapy prior to HSCT did not influence the outcome, but early iron reduction after HSCT (started before 6 months) improved RFS significantly after transplantation (56% in the control group vs. 90% in the treated group, respectively; p = .04). This study illustrates the impact of RBCT and related parameters on HSCT-outcome. Patients with an expected prolonged survival after transplantation may benefit from early iron reduction therapy after transplantation.
3.
[Effects of iron chelation therapy on allogeneic hematopoietic stem cell transplantation in myelodysplastic syndrome patients with iron overload]. [Chinese]
Gu, C. H., Li, C. X., Ye, L., Liu, H., Ma, J. F., Wang, T., Zou, Q., Chen, J., Chen, X. C., Wu, D. P.
Chung-Hua Hsueh Yeh Hsueh Tsa Chih: Chinese Journal of Hematology. 2016;37(3):189-93
Abstract
OBJECTIVE To investigate the effects of iron chelation therapy on hematopoietic reconstitution and related complications of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with myelodysplastic syndrome (MDS). METHODS Various clinical parameters were analyzed retrospectively in 57 MDS patients with iron overload who received allo-HSCT. According to the level of serum ferritin (SF) before transplantation divided patients into two groups: the effective treatment group (SF<1 000 mug/L) and iron overload group (SF>1 000 mug/L). RESULTS 130/57 cases were received iron chelation treatment, 27/57 patients didn' t received iron chelating therapy before transplantation. 19/30 cases were in the effective treatment group, and the median SF level before transplantation was 561 (223-846) mug/L. 11/30 cases were in the iron overload group, and the median SF level before transplantation was 1 262 (1 100-2 352) mug/L. The median SF level was 1 540 (1 320-3 112) mug/L of 27 patients didn't received iron chelating therapy before transplantation. 2 The rate of fully-engraftment in the effective treatment group and iron overload group was 19 cases (100.0% ) and 34 cases (89.5% ), myeloid reconstitution of 12(10-18) and 12(11-30) days respectively (P=0.441), and platelet reconstitution of 13(12-30) and 15 (10-32) days respectively (P=0.579). 3The infection risk rate of the effective treatment group was less than iron overload group [36.8% (7/19) vs 82.4% (28/34), P=0.002]. 4The incidence of aGVHD in effective treatment group was less than iron overload group [26.3%(5/19) vs 64.7%(22/34), P= 0.010]. All patients of the effective treatment group were I/II degree. 16 cases were I/II degree and 6 cases were III/IV degree in the iron overload group. 5 6 cases of iron overload group accepted iron chelation treatment early post-transplantation, and SF level decreased from 2 870 (2 205-3 580) mug/L to 1 270 (1 020-1 650) mug/L. 6The difference of median disease-free survival time between the effective treatment group and iron overload group was not statistically significant [28.9 (0.3-89.5) months vs 21.2(0.1-81.0) months, chi(2)=3.751, P=0.053]. CONCLUSIONS Iron overload obviously increased transplant-related complications, and effective iron chelation therapy before transplantation significantly decreased the incidence of infection and degree of aGVHD, thereby reduced the non-relapse mortality in patients with MDS.