Can hypertransfusion attenuate myelosuppression associated with combination chemotherapy in patients with inoperable bronchogenic carcinoma? A report of a randomised, controlled study

Abstract

Based on the concept of "stem-cell competition," hypertransfusion has been shown to attenuate the leucopenia associated with chemotherapy in children with leukemia. We conducted a randomized, controlled study of hypertransfusion in 25 patients with inoperable lung cancer who received combination chemotherapy consisting of methotrexate, adriamycin, cyclophosphamide, and CCNU (Lomustine) (MACC scheme). Twelve patients in the hypertransfusion group were given red cell transfusion to a hemoglobin value greater than or equal to 17 gm/dl prior to each chemotherapy cycle. The two groups of patients were comparable in age, cell type, extent of disease, performance status, and initial hemoglobin level and blood counts. The mean fall in granulocyte count was greater for control group (3.76 X 10(9)/liter) than for hypertransfusion group (3.27 X 10(9)/liter), and the mean fall in platelet count was greater for control group (53.84 X 10(9)/liter) than for hypertransfusion group (35.83 X 10(9)/liter), although the differences did not reach statistical significance (p greater than 0.05) partly because our MACC scheme was probably not sufficiently myelosuppressive to bring about a difference in the two groups. Granulocytopenia-associated infections were infrequent in both groups: two episodes in 37 cycles of chemotherapy in the hypertransfusion group and three episodes in 43 cycles in the control group. Hypertransfusion was simple and safe, and the encouraging trend towards less marked myelosuppression in our hypertransfused group would warrant further studies using more intensive and myelosuppressive combination chemotherapy regimens.

A multicenter pilot‐randomized controlled trial of the feasibility of an augmented red blood cell transfusion strategy for patients treated with induction chemotherapy for acute leukemia or stem cell transplantation

“…Other potential benefits may include more rapid neutrophil and PLT recovery, improved functional status, and improved quality of life. [50][51][52][53][54][55][56][57][58][59][60][61] In addition, a high pretransplant Hb level has been demonstrated to be associated with improved survival. 62 In contrast, there is evidence that, in certain patient populations, RBC transfusion may be associated with decreased early or long-term survival.…”

“…Based on experimental animal studies, 11 we have hypothesized that this effect may be especially important in patients with thrombocytopenia including patients with AML receiving induction chemotherapy and patients undergoing SCT. Other potential benefits may include more rapid neutrophil and PLT recovery, improved functional status, and improved quality of life 50‐61 . In addition, a high pretransplant Hb level has been demonstrated to be associated with improved survival 62 .…”

Reducing the red blood cell transfusion threshold from 8·0 g/dl to 7·0 g/dl in acute myeloid leukaemia patients undergoing induction chemotherapy reduces transfusion rates without adversely affecting patient outcome

“…Studies from the past century suggested that RBC transfusion could accelerate haematopoietic recovery in children with leukaemia [31,32]. There is also evidence that RBC transfusion attenuates chemotherapy‐induced myelosuppression in adults [33]. Although these studies used hypertransfusion with RBC concentrates aiming Hb levels of 16 g/dl and higher, we wanted to analyse whether different RBC transfusion rates had impact on CR rates or time to discharge from hospital (both depending on haematopoietic recovery).…”