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

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 (76Á1%) and 84 (23Á9%) 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 1Á5 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.

Perioperative red blood cell transfusion is associated with poor functional outcome and overall survival in patients with newly diagnosed glioblastoma

“…These more restrictive strategies allow for a significant reduction in blood consumption, resulting in lower patient exposure to allogeneic RBCs. The oncological literature favors rather more restrictive transfusion strategies, although in numerous studies, a threshold value of 7 g/dL seems to be acceptable [ 3 , 5 ]. In the current study, a restrictive transfusion strategy with a threshold value of 7 g/dL has been used in accordance with the hospital’s transfusion recommendation.…”

Fluid overload is associated with increased 90-day mortality in AML patients undergoing induction chemotherapy

“…In case of anemia symptoms, earlier RBC transfusion was allowed if deemed clinically indicated. Platelet concentrates were given if platelet count dropped below 10/nl or earlier if the patient presented with hemorrhage ( 24 ).…”

Treatment of Acute Leukemia During COVID-19: Focused Review of Evidence

“…A threshold of 7 g/dL before blood transfusion in AML is associated with comparable length of hospital stay, mortality, and treatment response rates while reducing resource utilization. 38 Likewise, a lower platelet cut off of 10,000/ul rather than 20,000/ul before prophylactic transfusion is safe and cost-effective without increasing the risk of bleeding. 39…”