Association between red blood cell transfusion dependence and burden in patients with myelodysplastic syndromes: A systematic literature review and meta‐analysis

Abstract

Myelodysplastic syndromes (MDS) are a group of malignant hematologic diseases characterized by ineffective hematopoiesis, which may lead to chronic anemia and transfusion dependency, with up to 30% of patients progressing to acute myeloid leukemia (AML). Studies suggest transfusion dependency may impact overall survival (OS); however, there is a lack of evidence concerning the association between transfusion status (TS) and OS in patients with MDS who become transfusion independent (TI) after treatment. In addition, the holistic impact of TS on other clinical, economic, and humanistic outcomes has not been well understood. We conducted a systematic literature review (SLR) to understand this impact. Ten studies were included and showed consistent decrease in OS in transfusion dependent (TD) compared with TI patients. These findings were confirmed by a meta‐analysis (MA) reporting better OS prognosis for TI patients. A second SLR was conducted to understand the association between TS and other clinical, economic, and humanistic outcomes. Twenty‐eight studies were included and showed better prognosis for other outcomes, including AML progression and leukemia‐free survival for TI patients. Risk of AML progression and cumulative non‐leukemic death assessed by the MA showed a trend toward worse prognosis and higher risk of AML progression for TD patients. Lower healthcare resource utilization, better quality of life, and reduced non‐leukemic death for TI patients were observed. Studies not eligible for MA also showed better clinical, economic, and humanistic outcomes for TI patients. These findings contribute to understanding the association between transfusion dependence and OS among other outcomes in patients with MDS.

The Analysis of the Effect of Blood Transfusion on Changes of Blood Platelet Parameters in Patients with Leukemia Treated with Chemotherapy

“…It is mainly divided into two types: acute lymphoblastic leukemia and acute myeloid leukemia [ 1 ], and the mortality is high in malignancies [ 2 ]. To prevent thrombocytopenia or bleeding, blood transfusion therapy is one of the supportive care measures for leukemia patients following cytotoxic chemotherapy [ 3 , 4 ]. However, during blood transfusion therapy, the body is stimulated to produce anti-platelet-associated antibodies due to the immune effect of leukocytes in blood products, affecting the effect of platelet transfusion, resulting in no significant increase in platelet count, bleeding symptoms are not significantly controlled, fever, allergy, and other adverse reactions may also occur, and intracranial hemorrhage may also be caused in severe cases [ 5 , 6 ].…”

The Proliferation Index of Erythroid Cells Predicts the Development of Transfusion-dependence in Myelodysplastic Syndrome Patients With Mildly Reduced Hemoglobin Levels at Initial Diagnosis

“…Transfusion‐dependence in myelodysplastic syndrome (MDS) patients significantly impairs their quality of life and prognosis of survival. Therefore, proper management of this severe complication is of utmost importance 1 . Current transfusion schedules for MDS patients include frequent visits to hospitals for blood sample collection to determine hemoglobin (Hb) levels and blood transfusion if necessary 2 .…”

“…Therefore, proper management of this severe complication is of utmost importance. 1 Current transfusion schedules for MDS patients include frequent visits to hospitals for blood sample collection to determine hemoglobin (Hb) levels and blood transfusion if necessary. 2 Despite these burdensome situations for the patient, more optimal approaches for management of transfusion-dependence are still under investigation.…”

Patterns of transfusion burden in an unselected population of patients with myelodysplastic syndromes: A population‐based study

“…Randomized controlled trials (RCTs) have shed some light on the burden of frequent blood transfusions in MDS patients, but this often only applies to a selection of the MDS population, such as low‐risk MDS patients with International Prognostic Scoring System (IPSS) <1.5 or patients without comorbidities 6‐8 . Given the heterogenic population of MDS patients, there is a relative knowledge‐to‐care gap on the transfusion burden in patients suffering from MDS in daily clinical practice 2, 9‐12 …”

“… 6 , 7 , 8 Given the heterogenic population of MDS patients, there is a relative knowledge‐to‐care gap on the transfusion burden in patients suffering from MDS in daily clinical practice. 2 , 9 , 10 , 11 , 12 …”