Unit:
Κατεύθυνση Θρόμβωση-Αιμορραγία-Ιατρική των μεταγγίσεωνLibrary of the School of Health Sciences
Supervisors info:
Μαριάννα Πολίτου, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Ελένη Παπαδάκη, Καθηγήτρια, Ιατρική Σχολή, Πανεπιστήμιο Κρήτης
Παναγιώτης Παναγιωτίδης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Μεταγγισιοθεραπεία σε ασθενείς με οξεία μυελογενή λευχαιμία και μυελοδυσπλαστικά σύνδρομα
Translated title:
Blood transfusion therapy in patients with acute myeloid leukemia and myelodysplastic syndromes
Summary:
Background: Blood product transfusion, mainly red blood cells and platelet concentrates is a common practice in patients with acute myeloid leukemia and myelodysplastic syndromes. Nevertheless it may have various side effects, it is expensive and sometimes difficult to apply. There is a tendency to adopt a restrictive strategy of transfusion in various clinical settings.
Methods: The aim of this study was to assess contemporary data of transfusion therapy in patients with AML and MDS. We identified studies by searching the National Library of Medicine through Pubmed as well as the Hellenic Academic Libraries-Link (HEAL-link). We also checked reference lists of other published articles and relevant papers.
Outcomes: A total of 36 studies were analyzed: 15 were prospective, 10 were randomized, 4 were retrospective, 5 were reviews, 5 were metaanalysis, 5 were observational using data from national or international registries, 1 was a survey and 1 was a guideline using the Delphi method. Furthermore we analyzed 4 articles, including patients with AML and MDS, with guidelines for blood transfusion therapy, 2 papers with guidelines for both blood and platelet transfusion and 3 articles with guidelines for platelet transfusion in this clinical setting.
Seven (7) studies reported on blood transfusion in patients with AML and MDS receiving intensive chemotherapy or/and allogeneic hemopoietic stem cell transplantation (HSCT). They showed non inferiority for the restrictive red cell transfusion policy (Hb<7gr/dl) versus a liberal one and reduction of the number of blood units transfused. Ten (10) studies- with small numbers of participants per study- reported on blood transfusion in patients with AML and MDS who were not on intensive treatment and showed low compliance rates with meeting specific hemoglobin (Hb) thresholds and a negative impact of transfusion density on progression free survival (PFS). Eleven (studies) reported on platelet transfusion of patients with AML and MDS. They favored prophylactic platelet transfusion for patients treated intensively and therapeutic platelet transfusion for patients after autologous HSCT. They described poor compliance with low platelet thresholds. In one of the two studies, which reported on FFP transfusion in this clinical setting, there was evidence that FFP transfusion protected those submitted to allogeneic HSCT from venoocclusive disease of the liver (VOD). Six studies reported on the influence of transfusion on Quality of Life (QoL) of patients with AML and MDS and showed non inferiority of a restrictive versus liberal transfusion treatment in patients treated intensively , a better QoL for patients with higher Hb if they were stable and not receiving intensive treatment and no impact of transfusion on patients at the end of life.
Inconsistencies were observed between the published guidelines, although the evidence they drew upon was practically the same. Most of them suggest that patients with AML and MDS, treated intensively, should follow a restrictive blood transfusion strategy (with a threshold of Hb =7-8gr/dl), taking into consideration any symptoms they have and a prophylactic platelet transfusion with a platelet threshold which may be modified , depending on the clinical setting.
Conclusions: The efficacy of blood transfusion therapy for patients with MDS and AML is not self-evident. A specific -one fitting for everyone-hemoglobin or platelet threshold is not enough to justify blood product transfusion. There is a need for personalized health care by introducing queries concerning QoL and bleeding risk both at diagnosis and during treatment or monitoring of these patients.
Main subject category:
Health Sciences
Keywords:
Acute myelogenous Leukemia , Myelodysplastic syndromes, Transfusion, Quality of life, Hemoglobin
Number of references:
167
