Major ABO Mismatch Increases Red Blood Cell Transfusion Requirements After Allogeneic Hematopoietic Cell Transplantation Using Total Lymphoid Irradiation and Anti-Thymoglobulin Conditioning

Little research has been done on changes in serum ferritin (s-ferritin) levels and clinical implications following allogeneic hematopoietic cell transplantation (HCT). We retrospectively evaluated the correlation of s-ferritin levels after HCT with survival in 203 patients. The s-ferritin level was significantly elevated, with 75% of the patients showing peak levels 90 days after HCT. The level was >10,000 ng/ml in a total of 43% of the patients, a finding that was associated with febrile neutropenia or infection. The s-ferritin level at day 30 and at 1 year after HCT was significantly associated with prognosis. However, this statistically significant relationship was lost after adjusting for acute-phase reactants. We conclude that hyperferritinemia is very common and the degree of influence of a red blood cell transfusion will vary depending on the phase after HCT. A prospective study is needed to determine if iron load in and of itself contributes to a worse prognosis after HCT. © 2014 S. Karger AG, Basel

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Incidence and Pattern of Graft-Versus-Host Disease in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation After Non-Myeloablative Conditioning with Total Lymphoid Irradiation and Antithymocyte Globulin

Biology of Blood and Marrow Transplantation ◽

10.1016/j.bbmt.2012.11.519 ◽

2013 ◽

Vol 19 (2) ◽

pp. S339-S340

Author(s):

Lauren Veltri ◽

Michael Regier ◽

Abraham Kanate ◽

Aaron Cumpston ◽

Sonia Leadmon ◽

...

Keyword(s):

Cell Transplantation ◽

Graft Versus Host Disease ◽

Antithymocyte Globulin ◽

Hematopoietic Cell Transplantation ◽

Hematopoietic Cell ◽

Allogeneic Hematopoietic Cell Transplantation ◽

Myeloablative Conditioning ◽

Host Disease ◽

Total Lymphoid Irradiation ◽

Graft Versus Host

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An intra-patient comparison of blood cell separators Spectra and Optia in patients and donors undergoing blood mononuclear cell collections at a single institution for subsequent autologous or allogeneic hematopoietic cell transplantation reveals comparable collection efficiencies

Bone Marrow Transplantation ◽

10.1038/bmt.2016.41 ◽

2016 ◽

Vol 51 (7) ◽

pp. 1007-1009 ◽

Cited By ~ 6

Author(s):

A Drezet ◽

A Granata ◽

C Lemarie ◽

B Calmels ◽

C Chabannon

Keyword(s):

Blood Cell ◽

Cell Transplantation ◽

Mononuclear Cell ◽

Hematopoietic Cell Transplantation ◽

Hematopoietic Cell ◽

Allogeneic Hematopoietic Cell Transplantation ◽

Single Institution

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

Journal of Clinical Oncology ◽

10.1200/jco.19.01836 ◽

2020 ◽

Vol 38 (13) ◽

pp. 1463-1473 ◽

Cited By ~ 6

Author(s):

Jason Tay ◽

David S. Allan ◽

Elizabeth Chatelain ◽

Doug Coyle ◽

Mohamed Elemary ◽

...

Keyword(s):

Standard Deviation ◽

Blood Cell ◽

Cell Transplantation ◽

Red Blood Cell ◽

Hematopoietic Cell Transplantation ◽

Hematopoietic Cell ◽

Absolute Difference ◽

Strategy Group ◽

Transfusion Strategy ◽

Rbc Transfusion

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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The Impact of Transfusion-Dependency on the Outcome of Patients with Myelodysplastic Syndromes (MDS) Receiving Allogeneic Peripheral Blood Stem Cell Transplantation after Myeloablative Conditioning.

Blood ◽

10.1182/blood.v110.11.1467.1467 ◽

2007 ◽

Vol 110 (11) ◽

pp. 1467-1467

Author(s):

Uwe Platzbecker ◽

Ulrich Germing ◽

Julian Stumpf ◽

Nikolaus Kröger ◽

Anne Böhm ◽

...

Keyword(s):

Blood Cell ◽

Cell Transplantation ◽

Red Blood Cell ◽

Peripheral Blood ◽

Hematopoietic Cell Transplantation ◽

Red Blood Cell Transfusion ◽

Prognostic Impact ◽

Myeloablative Conditioning ◽

Transfusion Dependency ◽

The Impact

Abstract Introduction: The majority of MDS patients become red blood cell transfusion-dependent during their clinical course. In fact, the presence or absence as well the extent of red blood cell transfusion-dependency (RBC-TD) has been recently shown to add significant prognostic information for an individual MDS patient treated with supportive care (BSC) only. Given the fact that allogeneic hematopoietic cell transplantation (HCT) is the only curative option for MDS patients, the aim of this study was to elucidate the role of RBC-TD on patient outcome. Methods: We report results of a retrospective multicenter German-Austrian study investigating 100 patients with MDS (RA(RS) n=33, RAEB n=33, RAEB-t n=19, CMMOL n=11, MDS/AML n=4) with either IPPS LOW (n=2), INT-1 (n=31), INT-2 (n=37) or HIGH (n=30) undergoing allogeneic myeloablative conditioning followed by peripheral blood stem cells (PBSC) from related (n=39) or unrelated donors (n=61). The median age of the patients was 50 years (range 18–68). Results: With a median follow-up of 32 months the 2-year overall survival (OS) was 48% for all patients and 64%, 50% and 34% for patients according to IPSS INT-1, INT-2 or HIGH, respectively (p=0.03 for INT-1 vs. HIGH). The 2-year OS of all patients was not different when comparing 68 patients displaying vs. 24 not displaying RBC-TD prior to PBSCT (46% vs. 55%, p=0.67). This holds also true when analyzing INT-1/INT-2 (n=62) as well as HIGH (n=27) patients separately. In a multivariate analysis only FAB classification (p=0.03) but not prior induction chemotherapy (n=18), presence of fibrosis (n=18), IPSS LOW/INT-1 vs. INT-2/HIGH, RBC-TD as well as ferritin level lower or above the median 973 μg/l (range 19–7000) had an impact on OS. Conclusion: These data suggest that the negative prognostic impact of RBC-TD in MDS patients receiving BSC can be overcome by myeloablative allogeneic PBSCT.

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