Optimal transfusion practices after allogeneic hematopoietic cell transplantation: a systematic scoping review of evidence from randomized controlled trials

Christou, Grace; Iyengar, Abhinav; Shorr, Risa; Tinmouth, Alan; Saidenberg, Elianna; Maze, Dawn; Tay, Jason; Bredeson, Christopher; Allan, David S.

doi:10.1111/trf.13738

Cited by 12 publications

(9 citation statements)

References 27 publications

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“…Standard transfusion practices were followed, to maintain target hemoglobin(Hb)/hematocrit values and platelet counts. [1][2][3][4][5][6] We note that transfusion medicine guidelines for patient hemoglobin and platelet counts evolved during 1993 through 2010, the period of this study. For example, NIH Clinical Center studies written during 1993 and 1994 (Protocols 93-H-0212, 94-H-0092, and 94-H-0182 in Appendix S1) recommended maintaining Hb greater than 9.0 g/ dL, while a later study from 2000 (Protocol 00-C-0119) specified Hb greater than 8.0 g/dL.…”

Section: Transfusion Practicesmentioning

confidence: 99%

Transfusion support for matched sibling allogeneic hematopoietic stem cell transplantation (1993–2010): factors that predict intensity and time to transfusion independence

et al. 2018

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Background: Patients undergoing allogeneic hematopoietic stem cell transplant (HCT) require variable, often extensive transfusion support. Identification of factors that predict urgent, intensive, or special needs should improve management of these patients. Study Design and Methods: This is a retrospective study of red blood cell (RBC) and platelet transfusion support provided for sequential matched sibling donor (MSD) allogeneic transplants conducted at the Clinical Center, NIH, from 1993-2010. Factors potentially important for predicting quantity of RBC and platelet transfusions, and time to transfusion independence through Day 200 post-HCT were evaluated. Results: Subjects (n=800) received 10,591 RBC and 10,199 platelet transfusions. Multivariable analysis demonstrated that need for RBC pretransplant, CD34+ dose, transplant year, diagnostic category, and ABO match were significantly independently associated with quantity of RBC transfusions Days 0-30. Only pretransplant need for RBC, CD34+ dose and transplant year had significance during Days 0-100. Similar analyses for quantity of platelet transfusions demonstrated that for both Days 0-30 and 0-100, significant factors were need for platelet support pretransplant, CD34+ dose, transplant year, and transplant regimen. Of note, long term, during Days 101-200, only CD34+ dose remained significant for quantity of RBC and of platelet transfusions. Analysis of time to transfusion independence demonstrated that patients with ABO major mismatches required longer to achieve freedom from RBC transfusion support compared to identical matches or those with minor mismatches. Conclusion: Patient-specific factors including CD34+ dose and ABO match of the graft should be given particular consideration by transfusion services when planning support of patients receiving allogeneic HCT.

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Section: Transfusion Practicesmentioning

confidence: 99%

Transfusion support for matched sibling allogeneic hematopoietic stem cell transplantation (1993–2010): factors that predict intensity and time to transfusion independence

et al. 2018

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“…Red blood cell transfusions are an integral part of the supportive therapy in patients undergoing hematopoietic stem cell transplantation (HSCT) to manage chemotherapy associated anemia. [1][2][3][4] However, there is little evidence to determine the appropriate use of red cell transfusions or the effects of red cell transfusions on clinical outcomes in patient with hematologic malignancies, in general, or specifically in HSCT. 2,5 While there are clear benefits of red cell transfusion in treating anemia, potential harm has been noted in a number of patient groups [6][7][8] .…”

Section: Introductionmentioning

confidence: 99%

“…Despite the unique challenge of balancing potential toxicities of transfusion with quality of life facing this group of patients 2,26 , there have been no randomised studies to guide optimal red cell transfusion. 1,2 Given the lack of evidence to guide practice, we designed a non-inferiority randomised controlled trial comparing the impact of a restrictive and a liberal red blood cell transfusion strategy on both health-related quality of life (HRQOL) and HSCT outcomes.…”

Section: Introductionmentioning

confidence: 99%

Liberal Versus Restrictive Red Blood Cell Transfusion Thresholds in Hematopoietic Cell Transplantation: A Randomized, Open Label, Phase III, Noninferiority Trial

Tay

Allan

Chatelain

et al. 2020

JCO

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PURPOSE Evidence regarding red blood cell (RBC) transfusion practices and their impact on hematopoietic cell transplantation (HCT) outcomes are poorly understood. PATIENTS AND METHODS We performed a noninferiority randomized controlled trial in four different centers that evaluated patients with hematologic malignancies requiring HCT who were randomly assigned to either a restrictive (hemoglobin [Hb] threshold < 70 g/L) or liberal (Hb threshold < 90 g/L) RBC transfusion strategy between day 0 and day 100. The noninferiority margin corresponds to a 12% absolute difference between groups in Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) score relative to baseline. The primary outcome was health-related quality of life (HRQOL) measured by FACT-BMT score at day 100. Additional end points were collected: HRQOL by FACT-BMT score at baseline and at days 7, 14, 28, 60, and 100; transplantation-related mortality; length of hospital stay; intensive care unit admissions; acute graft-versus-host disease; Bearman toxicity score; sinusoidal obstruction syndrome; serious infections; WHO Bleeding Scale; transfusion requirements; and reactions to therapy. RESULTS A total of 300 patients were randomly assigned to either restrictive-strategy or liberal-strategy treatment groups between 2011 and 2016 at four Canadian adult HCT centers. After HCT, mean pre-transfusion Hb levels were 70.9 g/L in the restrictive-strategy group and 84.6 g/L in the liberal-strategy group ( P < .0001). The number of RBC units transfused was lower in the restrictive-strategy group than in the liberal-strategy group (mean, 2.73 units [standard deviation, 4.81 units] v 5.02 units [standard deviation, 6.13 units]; P = .0004). After adjusting for transfusion type and baseline FACT-BMT score, the restrictive-strategy group had a higher FACT-BMT score at day 100 (difference of 1.6 points; 95% CI, −2.5 to 5.6 points), which was noninferior compared with that of the liberal-strategy group. There were no significant differences in clinical outcomes between the transfusion strategies. CONCLUSION In patients undergoing HCT, the use of a restrictive RBC transfusion strategy threshold of 70 g/L was as effective as a threshold of 90 g/L and resulted in similar HRQOL and HCT outcomes with fewer transfusions.

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“…Consequently, RBC must be removed from a bone marrow product before infusion when a high‐IHA titer is detected before HCT 2,7 . The transfusion strategy for the recipient is adapted to ABO mismatch situation 6,16 . Nevertheless, a major ABO mismatch correlates with a delay of multi‐lineage engraftment, that is, not only of RBC but also of platelets and neutrophils 17 .…”

Section: Introductionmentioning

confidence: 99%

Selective ABO immunoadsorption in hematopoietic stem cell transplantation with major ABO incompatibility

Crysandt

Soysal

Jennes

et al. 2021

European J of Haematology

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Objective ABO mismatch between donor and recipient occurs in 40% of allogeneic hematopoietic stem cell transplantations (HCT). Different strategies have been described to reduce isohemagglutinins (IHA) before HCT. We describe the effect of selective ABO immunoadsorption (ABO IA) on erythrocyte transfusion rate and the development of post‐transplant pure red cell aplasia (ptPRCA). Methods 63 patients with major ABO incompatibility were retrospectively analyzed. Nine patients with major ABO incompatibility and high‐IHA titer were treated by ABO IA before HCT. We analyzed the need for transfusion and the occurrence of ptPRCA. We compared the outcome with patients treated by other methods to reduce IHA. Results In all nine patients treated by ABO IA, IHA decreased in a median four times. PtPRCA occurred in one patient. The median number of transfusions was 8 (range: 0‐36) between d0 and d100. In 25 patients with high‐IHA titer without treatment or treated by other methods to reduce IHA, the need for transfusions was comparable. No difference in the incidence of ptPRCA was observed. Conclusions Selective ABO IA is a feasible, safe, and effective method to reduce IHA before HCT in major ABO incompatibility. No effect on transfusion rate or ptPRCA compared to other strategies could be observed.

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Optimal transfusion practices after allogeneic hematopoietic cell transplantation: a systematic scoping review of evidence from randomized controlled trials

Cited by 12 publications

References 27 publications

Transfusion support for matched sibling allogeneic hematopoietic stem cell transplantation (1993–2010): factors that predict intensity and time to transfusion independence

Transfusion support for matched sibling allogeneic hematopoietic stem cell transplantation (1993–2010): factors that predict intensity and time to transfusion independence

Liberal Versus Restrictive Red Blood Cell Transfusion Thresholds in Hematopoietic Cell Transplantation: A Randomized, Open Label, Phase III, Noninferiority Trial

Selective ABO immunoadsorption in hematopoietic stem cell transplantation with major ABO incompatibility

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