Blood transfusions can modify host immunity and clinical outcomes in hematological malignancies. One thousand sixty-seven patients with acute myeloid leukemia (AML) were studied for their transfusion dependency at initial presentation and transfusion frequency during induction chemotherapy. Three hundred five patients (29 %) showed initial dependence to red blood cell (RBC) transfusion and 109 (10 %) to platelet transfusion. Transfusion dependency at presentation was associated with a poorer prognosis. Both initial RBC and platelet transfusion needs were associated with lower response rates (P = 0.04 and P = 0.03). Median overall survival (OS) was 10.8 months for patients with RBC need vs 18.8 months for the other patients (P = 0.02) and 6.8 months for patients with platelet transfusion need vs 13.6 months for the others (P = 0.01). Similarly, transfusion intensity during induction therapy influenced negatively treatment outcome. Median transfusion burden per week was 2.5 (range 0-25.7) RBC units and 1.6 (range 0-15.7) platelet concentrates (PCs). Both high RBC and PC transfusion intensities were associated with lower response rates (P = 0.003 and P < 0.0001). Median OS was 9.08 months for patients with RBC transfusions >3/week vs 18.29 months for those with RBC transfusions ≤3/week (P = 0.0003) and 10.75 months for patients with PC transfusions >2/week vs 19.96 months for those with PC ≤2/week (P = 0.0003). RBC and platelet transfusion intensities during induction therapy remained of prognostic value in multivariate analysis. Transfusion need at presentation and the frequency of transfusions during induction chemotherapy appear as strong prognostic factors.
Background and Objectives Patients with aplastic anaemia or myelodysplastic syndromes frequently receive transfusions in an attempt to correct anaemia and/ or thrombocytopenia, putting them at risk of adverse transfusion reactions. The aim of this study is to evaluate the incidence and the types of adverse transfusion reactions in these patients.
Materials and MethodsAdverse transfusion reaction reported in transfused patients with aplastic anaemia or myelodysplastic syndromes from all the hospitals in the Auvergne-Rhône-Alpes region of France were extracted from the national haemovigilance database system and analysed. The types of adverse transfusion reactions, their incidence, their severity, the blood component involved and its imputability were evaluated.Results From 1 January 2010 to 30 June 2016, 7174 adverse transfusion reactions were reported. Seventy adverse transfusion reactions (0Á9%) were reported in patients with aplastic anaemia and 193 (2Á7%) in patients with myelodysplastic syndromes. Febrile non-haemolytic transfusion reaction was the most common reaction both aplastic anaemia (23 cases, 33Á0%) and myelodysplastic syndrome (56 cases, 29Á0%). Post-transfusion red blood cell alloimmunization was also high in both these groups (17Á1% in patients with aplastic anaemia and 22Á3% in patients with myelodysplastic syndrome) frequently involving anti-JK1 (Jk a ) specificity.Conclusion Febrile non-haemolytic transfusion reaction was the most common adverse transfusion reaction in patients with aplastic anaemia or myelodysplastic syndromes who received transfusions. Post-transfusion red blood cell alloimmunization was also observed frequently, but the use of RH-KEL 1 (Rhesus-Kell)matched red blood cell concentrates reduces this risk.
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