1.
Age, CD34+ cell dose, conditioning and pre-transplant cytopenias can help predict transfusion support in lymphoma patients undergoing autologous stem cell transplantation
Regalado-Artamendi, I., García-Fasanella, M., Medina, L., Fernandez-Sojo, J., Esquirol, A., García-Cadenas, I., Martino, R., Briones, J., Sierra, J., Novelli, S.
Vox sanguinis. 2023
Abstract
BACKGROUND AND OBJECTIVES Autologous stem cell transplant (ASCT) is a widely used therapy for lymphoma patients and can nowadays be performed on an outpatient basis. This study aimed to describe transfusion support in lymphoma patients undergoing ASCT and identify increased or prolonged transfusion requirement predictors. MATERIALS AND METHODS A retrospective study of all consecutive lymphoma patients undergoing ASCT between 2010 and 2020. RESULTS Out of 226 patients, 145 (64%) received red blood cell (RBC) transfusions, whereas all 226 (100%) required platelet transfusion (PT). Transfusions between Day +1 and +30 were higher in patients over 60 (2 [1-4] vs. 2 [0-2] RBC; p = 0.001 and 4 [2-8] vs. 3 [2-4] PT; p < 0.001); patients with pre-transplant anaemia (4 [2.5-6] vs. 2 [0-2] RBC; p < 0.001 and 5 [3-9] vs. 3 [2-4] PT; p = 0.001); pre-transplant thrombocytopenia (2 [1-4] vs. 2 [0-2] RBC; p < 0.001 and 4 [3-8.5] vs. 2 [1-3] PT; p < 0.001) or CD34(+) cell dose <4 × 10(6) /kg (2 [0-4] vs. 2 [0-2] RBC; p = 0.024 and 4 [2-6] vs. 2 [1-3.5] PT; p < 0.001). RBC transfusion independence was reached later in patients receiving carmustine, cytarabine, etoposide and melphalan (BEAM) (hazard ratio [HR] 1.6; confidence interval [CI] 1.1-2.3) and those requiring RBC before infusion and/or with pre-transplant anaemia (HR 2.2; CI 1.4-3.4). Age above 60 (HR 1.4; CI 1.0-1.9), BEAM conditioning (HR 1.4; CI 1.0-2.0) and pre-transplant thrombocytopenia and/or requiring PT before infusion (HR 1.8; CI 1.4-2.5) entailed longer time until PT independence. CONCLUSION These four factors (age ≥60 years; BEAM conditioning, CD34(+) dose <4 × 10(6) /kg and pre-transplant cytopenia and/or Day -10 to 0 transfusion) allowed dividing patients into three groups with significant differences between them regarding the time until transfusion independence.
2.
Increased blood transfusion after outpatient autologous transplantation with reduced-intensity conditioning for hematological malignancies predicts worse outcomes
Jaime-Pérez, J. C., Hernández-Coronado, M., Ancer-Rodríguez, J., Gómez-Almaguer, D.
Clinical transplantation. 2021;:e14247
Abstract
Transfusion has a recognized immunomodulatory effect and its role on the outcomes after an ambulatory autologous hematopoietic stem cell transplantation (auto-HSCT) following reduced-intensity conditioning (RIC) has not been documented. A study to assess factors associated with the number of packed red blood cells (PRBC) and platelet units transfused and their impact on survival rates of auto-HSCT recipients after RIC was conducted between 2013-2019. Transfusions were recorded from day 0-100. Of the 130 patients studied, seventy (53.9%) required transfusion support. The median number of PRBC transfused was 2 (range 1-20), for platelets it was also 2 units (range 1-19). Infused CD34+ cells/kg, pre-transplant CMV status and relapse/progression were significantly associated with the number of PRBC units transfused and sex, infused CD34+ cells/kg and pre-transplant CMV status with the number of platelet units transfused. In multivariate analysis, a high/very high Disease-Risk Index (p=0.001) (p=0.001) and transfusion of =5 total blood products (p=0.001) (p=0.010) were associated with decreased disease-free and overall survival. Two-year cumulative incidence of relapse was 50% for transfused patients vs. 34% for those not transfused (p=0.009). These data suggest that the transfusion burden and its interplay with other patient and transplant-related factors could be associated with inferior auto-HSCT outcomes.
3.
Can we transfuse wisely in patients undergoing chemotherapy for acute leukemia or autologous stem cell transplantation?
Lamarche, M. C., Hammond, D. E., Hopman, W. M., Sirosky-Yanyk, A., Shepherd, L., Bhella, S. D.
Transfusion. 2019
Abstract
BACKGROUND Transfusion of 2 units of red blood cells (RBCs) for Hb ≤80 g/L is the prevailing liberal practice for patients undergoing intensive treatment for acute leukemia or hematopoietic transplant across North America. There is little evidence regarding optimal transfusion targets in these highly transfusion-dependent patient populations. STUDY DESIGN AND METHODS This was a retrospective pre-post cohort study of consecutive patients admitted to Kingston Health Sciences Center between April through December 2016 (pre) and April through December 2017 (post) for acute leukemia induction chemotherapy or high dose chemotherapy (HDCT) for autologous stem cell transplantation (ASCT). The pre-cohort was transfused using a liberal threshold (2 units of RBCs for Hb ≤80 g/L) and the post-cohort using a more restrictive threshold (1 unit RBCs for Hb ≤70 g/L), implemented with a computerized physician order entry form. Primary outcome was number of RBC units transfused per inpatient day. Secondary outcomes included inpatient mortality and select morbidity measures. RESULTS 124 patients underwent 134 treatment courses: 62 courses of induction chemotherapy (pre = 26, post = 36) and 72 courses of HDCT for ASCT (pre = 39, post = 33). There was a significant decrease in median RBC utilization per admission in both patient populations: 10.5 versus 6.7 in the leukemia group (p = 0.01) and 2.0 versus 1.0 in the ASCT group (p = 0.04). This reduction was seen without a difference in inpatient mortality, length of stay, falls, serious bleeds, requirement for ICU, or time to engraftment post ASCT. CONCLUSIONS A restrictive transfusion strategy in patients receiving intensive chemotherapy for acute leukemia or ASCT decreased inpatient RBC usage without increasing adverse inpatient events.