Impact of red blood cell transfusion dose density on progression-free survival in patients with lower-risk myelodysplastic syndromes

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

  • Louise de Swart, Radboud University Nijmegen Medical Centre
  • ,
  • Simon Crouch, University of York
  • ,
  • Marlijn Hoeks, Radboud University Nijmegen Medical Centre, Sanquin Blood Supply Foundation
  • ,
  • Alex Smith, University of York
  • ,
  • Saskia Langemeijer, Radboud University Nijmegen Medical Centre
  • ,
  • Pierre Fenaux, Hôpital Saint-Louis
  • ,
  • Argiris Symeonidis, University of Patras
  • ,
  • Jaroslav Čermák, Institute of Hematology and Blood Transfusion
  • ,
  • Eva Hellström-Lindberg, Karolinska Institutet
  • ,
  • Reinhard Stauder, Innsbruck Medical University
  • ,
  • Guillermo Sanz, Hospital la Fe
  • ,
  • Moshe Mittelman, Tel Aviv University
  • ,
  • Mette Skov Holm
  • Luca Malcovati, Università Degli Studi di Pavia
  • ,
  • Krzysztof Mądry, Medical University of Warsaw
  • ,
  • Ulrich Germing, Heinrich Heine University Düsseldorf
  • ,
  • Aurelia Tatic, Fundeni Clinical Institute
  • ,
  • Aleksandar Savic, University of Novi Sad
  • ,
  • Antonio Medina Almeida, Hospital da Luz
  • ,
  • Njetočka Gredelj-Šimec, University of Zagreb
  • ,
  • Agnes Guerci-Bresler, Centre Hospitalier Universtaire Brabois Vandoeuvre
  • ,
  • Odile Beyne-Rauzy, CHU de Toulouse
  • ,
  • Dominic Culligan, Aberdeen Royal Infirmary
  • ,
  • Ioannis Kotsianidis, Democritus University of Thrace
  • ,
  • Raphael Itzykson, Hôpital Saint-Louis
  • ,
  • Corine van Marrewijk, Radboud University Nijmegen Medical Centre
  • ,
  • Nicole Blijlevens, Radboud University Nijmegen Medical Centre
  • ,
  • David Bowen, Leeds Teaching Hospitals NHS Trust
  • ,
  • Theo de Witte, Radboud University Medical Center

Progression-free survival (PFS) of patients with lower-risk myelodysplastic syndromes (MDS) treated with red blood cell transfusions is usually reduced, but it is unclear whether transfusion dose density is an independent prognostic factor. The European MDS Registry collects prospective data at 6-monthly intervals from newly diagnosed lower-risk myelodysplastic syndromes patients in 16 European countries and Israel. Data on the transfusion dose density - the cumulative dose received at the end of each interval divided by the time since the beginning of the interval in which the first transfusion was received - were analyzed using proportional hazards regression with time-varying co-variates, with death and progression to higher-risk MDS/acute myeloid leukemia as events. Of the 1,267 patients included in the analyses, 317 died without progression; in 162 patients the disease had progressed. PFS was significantly associated with age, EQ-5D index, baseline World Health Organization classification, bone marrow blast count, cytogenetic risk category, number of cytopenias, and country. Transfusion dose density was inversely associated with PFS (P<1x10-4): dose density had an increasing effect on hazard until a dose density of 3 units/16 weeks. The transfusion dose density effect continued to increase beyond 8 units/16 weeks after correction for the impact of treatment with erythropoiesis-stimulating agents, lenalidomide and/or iron chelators. In conclusion, the negative effect of transfusion treatment on PFS already occurs at transfusion densities below 3 units/16 weeks. This indicates that transfusion dependency, even at relatively low dose densities, may be considered as an indicator of inferior PFS. This trial was registered at www.clinicaltrials.gov as #NCT00600860.

OriginalsprogEngelsk
TidsskriftHaematologica
Vol/bind105
Nummer3
Sider (fra-til)632-639
Antal sider8
ISSN0390-6078
DOI
StatusUdgivet - 1 mar. 2020

Se relationer på Aarhus Universitet Citationsformater

ID: 181944648