title: Is the number of blood products transfused associated with lower survival in children with acute lymphoblastic leukemia?
abstract: BACKGROUND
  Blood transfusion during acute lymphoblastic leukemia (ALL) of childhood is scarcely documented. Children with ALL are immunosuppressed by both the disease and its therapy. Transfusion may contribute to the course of ALL through its transfusion-related immunomodulation (TRIM) effect.
  
  
  METHODS
  Blood transfusion history and response to therapy for 108 children <16 years of age at the time of ALL diagnosis was documented. Clinical files, electronic records, and blood bank registries were scrutinized. Overall survival (OS) and event-free survival (EFS) in relation to blood product type and number of transfusions was determined. Hazard ratios (HR) for death and relapse were estimated through uni- and multivariate Cox regression analysis.
  
  
  RESULTS
  One hundred eight ALL patients were included. Median age was 6 years (range: 0-15 years). Ninety-seven patients (89.8%) were transfused. Median number of transfused products was seven (range: 0-345). After multivariate analysis, transfusion of >5 packed red blood cells (PRBC) remained a significant predictor for death (P = 0.003) and relapse (P = 0.011). For platelets, maximal significance was observed when >30 platelet concentrates (PC) were transfused (P < 0.001). When both, PRBC and PC were considered, maximal significance for predicting death was observed with transfusion of >30 blood products (P < 0.001).
  
  
  CONCLUSIONS
  The number of blood products transfused to children with ALL appears to be significantly associated with lower survival rates. This may reflect both the severity of the disease and the TRIM effect, which may decrease immune surveillance capacity and the probability of leukemic clone eradication.
authors.affiliation: Internal Medicine Division, Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico. carjaime@hotmail.com
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Jaime-Pérez
authors.forename: Perla R
authors.initials: PR
authors.lastname: Colunga-Pedraza
authors.forename: David
authors.initials: D
authors.lastname: Gómez-Almaguer
mesh_terms: D000293:Adolescent; D001803:Blood Transfusion / Q000379:methods; D002648:Child; D002675:Child, Preschool; D046528:Chimerism; D018572:Disease-Free Survival; D006801:Humans; D056747:Immunomodulation; D007223:Infant; D007231:Infant, Newborn; D047589:Leukocyte Reduction Procedures; D015999:Multivariate Analysis; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000276:immunology / Q000628:therapy*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D065227:Transfusion Reaction