title: Transfusion dependency at diagnosis and transfusion intensity during initial chemotherapy are associated with poorer outcomes in adult acute myeloid leukemia.
abstract: Blood transfusions can modify host immunity and clinical outcomes in hematological malignancies. One thousand sixty-seven patients with acute myeloid leukemia (AML) were studied for their transfusion dependency at initial presentation and transfusion frequency during induction chemotherapy. Three hundred five patients (29 %) showed initial dependence to red blood cell (RBC) transfusion and 109 (10 %) to platelet transfusion. Transfusion dependency at presentation was associated with a poorer prognosis. Both initial RBC and platelet transfusion needs were associated with lower response rates (P = 0.04 and P = 0.03). Median overall survival (OS) was 10.8 months for patients with RBC need vs 18.8 months for the other patients (P = 0.02) and 6.8 months for patients with platelet transfusion need vs 13.6 months for the others (P = 0.01). Similarly, transfusion intensity during induction therapy influenced negatively treatment outcome. Median transfusion burden per week was 2.5 (range 0-25.7) RBC units and 1.6 (range 0-15.7) platelet concentrates (PCs). Both high RBC and PC transfusion intensities were associated with lower response rates (P = 0.003 and P < 0.0001). Median OS was 9.08 months for patients with RBC transfusions >3/week vs 18.29 months for those with RBC transfusions ≤3/week (P = 0.0003) and 10.75 months for patients with PC transfusions >2/week vs 19.96 months for those with PC ≤2/week (P = 0.0003). RBC and platelet transfusion intensities during induction therapy remained of prognostic value in multivariate analysis. Transfusion need at presentation and the frequency of transfusions during induction chemotherapy appear as strong prognostic factors.
authors.affiliation: Hemovigilance Department, Hospices Civils de Lyon, Edouard Herriot and Croix-Rousse Hospitals, Lyon, France.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Cannas
authors.affiliation: Hematology Department, Hospices Civils de Lyon, Lyon-Sud Hospital, 165 chemin du Grand Revoyet, 69495, Pierre Bénite, France.
authors.forename: Jihane
authors.initials: J
authors.lastname: Fattoum
authors.affiliation: Etablissement Français du Sang, Blood Bank Center, Lyon, Rhône-Alpes, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Raba
authors.affiliation: Hemovigilance Department, Hospices Civils de Lyon, Edouard Herriot and Croix-Rousse Hospitals, Lyon, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Dolange
authors.affiliation: Etablissement Français du Sang, Blood Bank Center, Lyon, Rhône-Alpes, France.
authors.forename: Gregory
authors.initials: G
authors.lastname: Barday
authors.affiliation: Etablissement Français du Sang, Blood Bank Center, Lyon, Rhône-Alpes, France.
authors.forename: Marion
authors.initials: M
authors.lastname: François
authors.affiliation: Hematology Department, Hospices Civils de Lyon, Lyon-Sud Hospital, 165 chemin du Grand Revoyet, 69495, Pierre Bénite, France.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Elhamri
authors.affiliation: Hematology Department, Hospices Civils de Lyon, Lyon-Sud Hospital, 165 chemin du Grand Revoyet, 69495, Pierre Bénite, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Salles
authors.affiliation: Hematology Department, Hospices Civils de Lyon, Lyon-Sud Hospital, 165 chemin du Grand Revoyet, 69495, Pierre Bénite, France. xavier.thomas@chu-lyon.fr.
authors.forename: Xavier
authors.initials: X
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy / Q000706:statistics & numerical data; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: Acute myeloid leukemia; Chemotherapy; Prognosis; Transfusion dependency; Transfusion intensity