The Impact of Prolonged Storage of Red Blood Cells on Cancer Survival

Abstract

BackgroundThe duration of storage of transfused red blood cells (RBC) has been associated with poor clinical outcomes in some studies. We sought to establish whether prolonged storage of transfused RBC in cancer patients influences overall survival (OS) or cancer recurrence.Methods and FindingsPatients diagnosed with cancer at The Ottawa Regional Cancer Centre between January 01, 2000 and December 31, 2005 were included (n = 27,591) where 1,929 (7.0%) received RBC transfusions within one year from diagnosis. Transfused RBC units were categorized as “new” if stored for less than 14 days, “intermediate” if stored between 14 and 28 days and “old” if stored for more than 28 days. Baseline characteristics between the comparative groups were compared by ANOVA test. Categorical variables and continuous variables were compared using Chi-squared and Wilcoxan rank-sum tests respectively. Overall survival was not associated with duration of storage of transfused RBC with a median survival of 1.2, 1.7, 1.1 years for only new, intermediate and old RBC units respectively (p = 0.36). Cancer recurrence was significantly higher in patients who received a RBC transfusion than those who did not (56.3% vs 33.0% respectively; p<0.0001) but was not affected by the duration of storage of transfused RBC (p = 0.06). In multivariate analysis, lung cancer, advanced stage, chemotherapy, radiation, cancer-related surgery and cancer recurrence were associated with inferior OS (p<0.05), while age, advanced stage, lung cancer, and more than 6 units of blood transfused were associated with cancer recurrence (p<0.05). The duration of storage of RBC before transfusion was not associated with OS or cancer recurrence in multivariate analysis.ConclusionIn patients diagnosed with cancer, the duration of storage of transfused RBC had no impact on OS or cancer recurrence. This suggests that our current RBC storage policy of providing RBC of variable duration of storage for patients with malignancy is safe.

Transfusion of red blood cells does not impact progression‐free and overall survival after surgery for ovarian cancer

“…Nonetheless, Kaplan–Meier curves were nearly identical so that it is unlikely that the loss of statistical power debilitated the validity to detect a significant difference between patients receiving a transfusion of RBCs and patients that were not transfused. So far, there is still limited evidence to suggest to which extent transfusion of RBC that were stored for prolonged intervals may increase the risk for recurrent disease after cancer surgery . Finally, given a potential dose–response relationship between the number of transfused RBC units and the risk for a recurrent disease after cancer surgery, a median of 4 units of RBCs in the study population, and 2 units of RBCs in the matched cohort might have been insufficient to cause immunosuppressive effects.…”

Aged erythrocytes: a fine wine or sour grapes?

“…Although cancer recurrence was significantly higher in patients who received erythrocyte transfusion than those who did not, this effect was not related to the duration of RBC storage. 24…”

Allogeneic blood and postoperative cancer outcomes: correlation or causation?

“…Kekre et al. reviewed 27,000 cancer patients treated by means of chemoradiotherapy or surgery of whom 1929 had been transfused . Although the authors found significantly higher levels of cancer recurrence among transfused patients, there was no association with red cell storage duration (≤ 14 days vs. 14–28 days vs. > 28 days).…”

“…In cases of hepatocellular carcinoma, some authors claim a link between FFP administration and worsening overall survival [19], although others evaluating disease-free survival have demonstrated no effect [20]. been transfused [22]. Although the authors found significantly higher levels of cancer recurrence among transfused patients, there was no association with red cell storage duration (≤ 14 days vs. 14-28 days vs. > 28 days).…”