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


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.


CONCLUSIONS
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.
Xenocostas
Anargyros
A
Hematology Division, London Health Sciences Center, University of Western Ontario, Canada. anargyros.xenocosta@lhsc.on.ca
Yee
Angelina
A
Wong
Cindy J
CJ
Sutton
David M C
DM
Lipton
Jeffrey H
JH
Kiss
Thomas L
TL
Messner
Hans A
HA
D000293:Adolescent; D000328:Adult; D000368:Aged; D001787:Blood Group Incompatibility; D016026:Bone Marrow Transplantation / Q000401:mortality*; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000628:therapy; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D012727:Sex Characteristics; D013997:Time Factors; D014019:Tissue Donors; D014184:Transplantation, Homologous
D006454:Hemoglobins