Olivier Ballo1, Philine Fleckenstein1, Fagr Eladly1, Eva-Maria Kreisel1, Jan Stratmann1, Erhard Seifried2, Markus Müller2, Hubert Serve1,3, Gesine Bug1, Halvard Bonig2, Christian H Brandts1,3,4, Fabian Finkelmeier5. 1. Department of Medicine, Hematology/Oncology, University Hospital, Goethe University, Frankfurt/Main, Germany. 2. Institute of Transfusion Medicine and Immunohematology, German Red Cross Blood Service Baden-Württemberg-Hessen, Goethe University, Frankfurt/Main, Germany. 3. German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany. 4. University Cancer Center Frankfurt (UCT), University Hospital, Goethe University, Frankfurt/Main, Germany. 5. Department of Medicine, Gastroenterology, Hepatology and Endocrinology, University Hospital, Goethe University, Frankfurt/Main, Germany.
Abstract
BACKGROUND AND OBJECTIVES: Red blood cell (RBC) transfusions are needed by almost every acute myeloid leukaemia (AML) patient undergoing induction chemotherapy and constitute a cornerstone in supportive measures for cancer patients in general. Randomized controlled trials have shown non-inferiority or even superiority of restrictive transfusion guidelines over liberal transfusion guidelines in specific clinical situations outside of medical oncology. In this study, we analysed whether more restrictive RBC transfusion reduces blood use without affecting hard outcomes. MATERIALS AND METHODS: A total of 352 AML patients diagnosed between 2007 and 2018 and undergoing intensive induction chemotherapy were included in this retrospective analysis. In the less restrictive transfusion group, patients received RBC transfusion for haemoglobin levels below 8 g/dl (2007-2014). In the restrictive transfusion group, patients received RBC transfusion for haemoglobin levels below 7 g/dl (2016-2018). Liberal transfusion triggers were never endorsed. RESULTS: A total of 268 (76·1%) and 84 (23·9%) AML patients fell into the less restrictive and restrictive transfusion groups, respectively. The less restrictive transfusion group had 1 g/dl higher mean haemoglobin levels, received their first RBC transfusions earlier and needed 1·5 more units of RBC during the hospital stay of induction chemotherapy. Febrile episodes, C-reactive protein levels, admission to the intensive care unit, length of hospital stay as well as response and survival rates did not differ between the two cohorts. CONCLUSION: From our retrospective analysis, we conclude that a more restrictive transfusion trigger does not affect important outcomes of AML patients. The opportunity to test possible effects of the more severe anaemia in the restrictive transfusion group on quality of life was missed.
BACKGROUND AND OBJECTIVES: Red blood cell (RBC) transfusions are needed by almost every acute myeloid leukaemia (AML) patient undergoing induction chemotherapy and constitute a cornerstone in supportive measures for cancerpatients in general. Randomized controlled trials have shown non-inferiority or even superiority of restrictive transfusion guidelines over liberal transfusion guidelines in specific clinical situations outside of medical oncology. In this study, we analysed whether more restrictive RBC transfusion reduces blood use without affecting hard outcomes. MATERIALS AND METHODS: A total of 352 AMLpatients diagnosed between 2007 and 2018 and undergoing intensive induction chemotherapy were included in this retrospective analysis. In the less restrictive transfusion group, patients received RBC transfusion for haemoglobin levels below 8 g/dl (2007-2014). In the restrictive transfusion group, patients received RBC transfusion for haemoglobin levels below 7 g/dl (2016-2018). Liberal transfusion triggers were never endorsed. RESULTS: A total of 268 (76·1%) and 84 (23·9%) AMLpatients fell into the less restrictive and restrictive transfusion groups, respectively. The less restrictive transfusion group had 1 g/dl higher mean haemoglobin levels, received their first RBC transfusions earlier and needed 1·5 more units of RBC during the hospital stay of induction chemotherapy. Febrile episodes, C-reactive protein levels, admission to the intensive care unit, length of hospital stay as well as response and survival rates did not differ between the two cohorts. CONCLUSION: From our retrospective analysis, we conclude that a more restrictive transfusion trigger does not affect important outcomes of AMLpatients. The opportunity to test possible effects of the more severe anaemia in the restrictive transfusion group on quality of life was missed.
Authors: Olivier Ballo; Fagr Eladly; Sebastian Koschade; Stefan Büttner; Jan Alexander Stratmann; Uta Brunnberg; Eva-Maria Kreisel; Franziska Frank; Sebastian Wagner; Björn Steffen; Hubert Serve; Fabian Finkelmeier; Christian H Brandts Journal: Ann Hematol Date: 2021-07-25 Impact factor: 3.673