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RBC transfusion requirements after allogeneic marrow transplantation: impact of the before-transplant Hb level on transfusion and early survival

Authors

  • Anargyros Xenocostas,

    1. From the London Health Sciences Center, University of Western Ontario, London;
    2. The Princess Margaret Hospital, University Health Network and The University of Toronto, Toronto;
    3. Robarts Clinical Trials, Robarts Research Institute, London, Ontario, Canada.
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  • Angelina Yee,

    1. From the London Health Sciences Center, University of Western Ontario, London;
    2. The Princess Margaret Hospital, University Health Network and The University of Toronto, Toronto;
    3. Robarts Clinical Trials, Robarts Research Institute, London, Ontario, Canada.
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  • Cindy J. Wong,

    1. From the London Health Sciences Center, University of Western Ontario, London;
    2. The Princess Margaret Hospital, University Health Network and The University of Toronto, Toronto;
    3. Robarts Clinical Trials, Robarts Research Institute, London, Ontario, Canada.
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  • David M.C. Sutton,

    1. From the London Health Sciences Center, University of Western Ontario, London;
    2. The Princess Margaret Hospital, University Health Network and The University of Toronto, Toronto;
    3. Robarts Clinical Trials, Robarts Research Institute, London, Ontario, Canada.
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  • Jeffrey H. Lipton,

    1. From the London Health Sciences Center, University of Western Ontario, London;
    2. The Princess Margaret Hospital, University Health Network and The University of Toronto, Toronto;
    3. Robarts Clinical Trials, Robarts Research Institute, London, Ontario, Canada.
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  • Thomas L. Kiss,

    1. From the London Health Sciences Center, University of Western Ontario, London;
    2. The Princess Margaret Hospital, University Health Network and The University of Toronto, Toronto;
    3. Robarts Clinical Trials, Robarts Research Institute, London, Ontario, Canada.
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  • Hans A. Messner

    1. From the London Health Sciences Center, University of Western Ontario, London;
    2. The Princess Margaret Hospital, University Health Network and The University of Toronto, Toronto;
    3. Robarts Clinical Trials, Robarts Research Institute, London, Ontario, Canada.
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  • ABBREVIATIONS:

    ALL = acute lymphoblastic leukemia; alloBMT = allogeneic marrow transplantation; AML = acute myeloid leukemia; CML = chronic myeloid leukemia; HR = hazard ratio; PBPC(s) = peripheral blood progenitor cell(s); PT-Hb = Hb level before BMT.

  • Project support and fellowship funding for A.X. was provided by Ortho Biotech, Canada.

Address reprint requests to: A. Xenocostas, MD, Hematology Division, Room 2760, LHSC, Westminster Site, 800 Commissioners Road East, London, Ontario, Canada N6A 4G5;e-mail: anargyros.xenocostas@lhsc.on.ca .

Abstract

BACKGROUND : Most patients undergoing allogeneic marrow transplantation (alloBMT) require transfusions of RBCs. A retrospective analysis was performed to evaluate the utilization and risk factors for RBC transfusions including age and sex of recipient, HLA matching between donor and recipient, disease status at time of BMT, the occurrence of GVHD, ABO blood group compatibility, the source of progenitor cells and the Hb level before BMT (PT-Hb).

STUDY DESIGN AND METHODS : Data from 519 consecutive patients receiving transplants between January 1995 and March 2000 were reviewed. The number of RBC transfusions was determined for the following periods: 0 to 60, 61 to 120, and 121 to 180 days after BMT.

RESULTS : The transfusion requirements were greatest during the first 60 days after BMT and decreased with time. The total number of units transfused to this cohort of patients was 5398, of which 3505 units were utilized within the first 2 months. The mean number ± SD of units transfused per patient from 0 to 60 days was 6.8 ± 6.4; 61 to 120 days, 3.2 ± 5.5; and 121 to 180 days, 2.0 ± 4.6. An increased transfusion requirement was associated with lower PT-Hb, major ABO mismatch between donor and recipient, BMT in patients with more advanced disease, use of unrelated donors, older age, and female sex by Spearman's correlation analysis. The source of progenitor cells and the development of GVHD did not influence transfusion requirements. Increased mortality during the 6-month period after transplant was associated with lower PT-Hb, use of unrelated donors, advanced disease status at BMT, and sex by Cox regression analysis. In a multivariate model, PT-Hb remained significant when controlling for the other risk factors.

CONCLUSION : The PT-Hb was identified as an independent risk factor for RBC transfusions during alloBMT. As well, a lower PT-Hb was found to be an independent risk factor for increased mortality during the 6-month study period.

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