title: Association between Transfusion Status and Overall Survival in Patients with Myelodysplastic Syndromes: A Systematic Literature Review and Meta-Analysis.
abstract: Multiple studies show that transfusion independence (TI) in myelodysplastic syndrome (MDS) has a positive impact on overall survival (OS). To assess this, a systematic review and meta-analysis of the association between TI and OS in patients with MDS was conducted (PROSPERO ID: CRD42014007264).
  
  
  
  Comprehensive searches of 5 key bibliographic databases were conducted and supplemented with additional search techniques. Included were studies that had recruited adults aged >18 years with MDS and had examined the impact of transfusion status on OS.
  
  
  
  Fifty-five studies (89 citations) were included. The vast majority reported a statistically significant hazard ratio (HR) for OS in favor of TI patients or in patients who acquired TI after treatment. A random-effects meta-analysis was conducted. Patients classed as TI at baseline showed a 59% decrease in the risk of death compared with transfusion-dependent (TD) patients [HR 0.41; 95% credible interval (CrI) 0.29-0.56], and this effect did not appear to interact significantly with illness severity (interaction coefficient HR 1.38; 95% CrI 0.62-3.41). A meta-analysis of studies where patients acquired TI was not possible, but those studies consistently reported a survival benefit for those who acquired TI.
  
  
  
  The findings revealed a 59% pooled reduction in mortality among TI patients when compared with TD patients.
authors.affiliation: Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors.forename: Sue
authors.initials: S
authors.lastname: Harnan
authors.forename: Shiji
authors.initials: S
authors.lastname: Ren
authors.forename: Tim
authors.initials: T
authors.lastname: Gomersall
authors.forename: Emma S
authors.initials: ES
authors.lastname: Everson-Hock
authors.forename: Anthea
authors.initials: A
authors.lastname: Sutton
authors.forename: Sujith
authors.initials: S
authors.lastname: Dhanasiri
authors.forename: Austin
authors.initials: A
authors.lastname: Kulasekararaj
mesh_terms: D001803:Blood Transfusion; D006801:Humans; D009190:Myelodysplastic Syndromes; D017713:Platelet Transfusion