1
|
Miller L, Freed-Freundlich M, Shimoni A, Hellou T, Avigdor A, Misgav M, Canaani J. Defining Current Patterns of Blood Product Use during Intensive Induction Chemotherapy in Newly Diagnosed Acute Myeloid Leukemia Patients. Transfus Med Hemother 2023; 50:456-468. [PMID: 37899992 PMCID: PMC10601600 DOI: 10.1159/000529595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/06/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Blood product transfusion retains a critical role in the supportive care of patients with acute myeloid leukemia (AML). Whereas previous studies have shown increased transfusion dependency to portend inferior outcome, predictive factors of an increased transfusion burden and the prognostic impact of transfusion support have not been assessed recently. Methods/Patients We performed a retrospective analysis on a recent cohort of patients given intensive induction chemotherapy in 2014-2022. Results The analysis comprised 180 patients with a median age of 57 years with 80% designated as de novo AML. Fifty-four patients (31%) were FLT3-ITD mutated, and 73 patients (42%) harbored NPM1. Favorable risk and intermediate risk ELN 2017 patients accounted for 43% and 34% of patients, respectively. The median number of red blood cell (RBC) and platelet units given during induction were 9 and 7 units, respectively. Seventeen patients (9%) received cryoprecipitate, and fresh frozen plasma (FFP) was given to 12 patients (7%). Lower initial hemoglobin and platelet levels were predictive of increased use of RBC (p < 0.0001) and platelet transfusions (p < 0.0001). FFP was significantly associated with induction related mortality (42% vs. 5%; p < 0.0001) and with FLT3-ITD (72% vs. 28%; p = 0.004). Blood group AB experienced improved mean overall survival compared to blood group O patients (4.1 years vs. 2.8 years; p = 0.025). In multivariate analysis, increased number of FFP (hazard ratio [HR], 4.23; 95% confidence interval [CI], 2.1-8.6; p < 0.001) and RBC units (HR, 1.8; 95% CI, 1.2-2.8; p = 0.008) given was associated with inferior survival. Conclusion Transfusion needs during induction crucially impact the clinical trajectory of AML patients.
Collapse
Affiliation(s)
- Liron Miller
- Blood Bank and Transfusion Service, Chaim Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Mor Freed-Freundlich
- Hematology Division, Chaim Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Avichai Shimoni
- Hematology Division, Chaim Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Tamer Hellou
- Hematology Division, Chaim Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Abraham Avigdor
- Hematology Division, Chaim Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Mudi Misgav
- Blood Bank and Transfusion Service, Chaim Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Jonathan Canaani
- Hematology Division, Chaim Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| |
Collapse
|
2
|
Ogbenna AA, Oyedeji OA, Famuyiwa CO, Sopekan BA, Damulak OD, Akpatason EB, Olorunfemi G, Adekola K. Outcome of acute myeloid leukaemia in Nigeria: clinician's perspective. Ecancermedicalscience 2021; 15:1239. [PMID: 34221122 PMCID: PMC8225339 DOI: 10.3332/ecancer.2021.1239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Indexed: 11/26/2022] Open
Abstract
The outcome of acute myeloid leukaemia (AML) has remained a major concern even in developed countries. In resource poor countries, it is envisaged that the outcome will be far worse because of late presentations, lack of appropriate diagnostic facilities and supportive care. However, data to validate this is lacking and many of these countries lack an effective cancer registry. This study determined the clinician’s perspective of the outcome of care of AML patients in Nigeria and their attitudes to the care of these patients. Structured self-administered questionnaire was used to assess the clinician’s perception of outcomes of care, contributory factors and attitude to care of AML patients. Ninety-eight percent of clinicians reported that the outcome of care was suboptimal; 73.3% and 90.6% of the clinicians reported having less than 31% of AML patients surviving induction and post-induction therapies, respectively. Sixty-six-point one percent (66.1%), 50% and 62.7% of the clinicians have never used immunophenotyping, cytogenetic or molecular studies, respectively, in the management of AML patients under their care. Access to blood components other than Red cells was low; 23.3% had access to apheresis platelets and 55% to fresh frozen plasma. Forty-six percent of clinicians will either give half dose of chemotherapy or offer only supportive care. This reported early death rate is three times higher than that reported in developed countries with only 9% likely to survive the first year of induction compared to about 32.9% in Ontario. Approximately 28 units of pooled or apheresis derived platelet may be required in course of therapy but just 10% of clinicians have access to platelet apheresis. Lack of diagnostic facilities, blood components and clinicians’ attitudes are contributing factors to the extremely poor outcomes of patients with AML in Nigeria.
Collapse
Affiliation(s)
- Ann Abiola Ogbenna
- Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Idi-Araba, Lagos, PMB 12003, Nigeria.,https://orcid.org/0000-0003-1441-2308
| | - Olufemi Abiola Oyedeji
- Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | | | - Obadiah Dapus Damulak
- Department of Haematology and Blood Transfusion, Faculty of Clinical Sciences, College of Health Sciences, University of Jos, Nigeria
| | | | - Gbenga Olorunfemi
- Division of Epidemiology and Biostatistics, School of Public Health, University of Witwatersrand, Johannesburg, South Africa.,https://orcid.org/0000-0001-6634-8550
| | - Kehinde Adekola
- Hem-Onc Stem Cell Transplant Unit, Division of Hematology-Oncology, Northwestern Memorial Hospital, Northwestern University, Feinberg School of Medicine, 676 North St. Clair Street, Suite 850, IL 60611, Chicago, USA
| |
Collapse
|
3
|
Bowman Z, Fei N, Ahn J, Wen S, Cumpston A, Shah N, Craig M, Perrotta PL, Kanate AS. Single versus double-unit transfusion: Safety and efficacy for patients with hematologic malignancies. Eur J Haematol 2019; 102:383-388. [PMID: 30664281 DOI: 10.1111/ejh.13211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Although hemoglobin thresholds for red blood cell (RBC) transfusion have decreased, double-unit RBC transfusion practices persist. We studied the effects switching from predominantly double-unit to single-unit RBC transfusions had on utilization and clinical outcomes for malignant hematology patients. METHODS Retrospective chart review compared malignant hematology patients before and after implementing single-unit RBC transfusion policy. Hemoglobin threshold was 8.0 g/dL for both groups. RBC utilization metrics included number of RBC units transfused, RBC units transfused per admission, and number of transfusion episodes. Clinical outcomes included length of stay, 30-day mortality, and outpatient RBC transfusion 30-days post-discharge. RESULTS Baseline hemoglobin was similar in both groups. The single-unit group was transfused with fewer RBC units per admission (5.1 vs 4.5, P = 0.01) than the double-unit group, but had more transfusion episodes per admission (4.1 vs 2.7, P < 0.001). After implementing single-unit policy, a 29% reduction in RBC utilization was observed. Mean hemoglobin at discharge was lower in the single-unit group (8.9 vs 9.5 g/dL, P = 0.005). No significant differences in length of stay or 30-day mortality were observed. CONCLUSION Transfusing malignant hematology patients with single RBC units is safe and efficacious. Electronic provider order systems facilitating RBC transfusion requests provide excellent adherence to transfusion policy.
Collapse
Affiliation(s)
- Zelia Bowman
- Department of Hematology/Oncology, West Virginia University, Morgantown, West Virginia
| | - Naomi Fei
- Department of Hematology/Oncology, West Virginia University, Morgantown, West Virginia
| | - Janice Ahn
- Department of Pathology, West Virginia University, Morgantown, West Virginia
| | - Sijin Wen
- Department of Biostatistics, School of Public Health, West Virginia University, Morgantown, West Virginia
| | - Aaron Cumpston
- Department of Pharmacy, West Virginia University Hospitals, Morgantown, West Virginia.,Alexander B. Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, West Virginia
| | - Nilay Shah
- Alexander B. Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, West Virginia
| | - Michael Craig
- Alexander B. Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, West Virginia
| | - Peter L Perrotta
- Department of Pathology, West Virginia University, Morgantown, West Virginia
| | - Abraham S Kanate
- Alexander B. Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, West Virginia
| |
Collapse
|
4
|
Han B, Chen C, Wang L, Tan B, Huang C, Qin L, Zhu H. Blood transfusion for patients with newly diagnosed acute myeloid leukaemia undergoing induction chemotherapy in a large medical centre in China: a retrospective analysis. Transfus Med 2016; 26:383-384. [PMID: 27569439 DOI: 10.1111/tme.12339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 07/27/2016] [Indexed: 02/05/2023]
Affiliation(s)
- B Han
- Department of Laboratory Medicine, West China Hospital
| | - C Chen
- Department of Laboratory Medicine, West China Hospital
| | - L Wang
- Department of Laboratory Medicine, West China Hospital
| | - B Tan
- Department of Laboratory Medicine, West China Hospital
| | - C Huang
- Department of Laboratory Medicine, West China Hospital
| | - L Qin
- Department of Laboratory Medicine, West China Hospital.
| | - H Zhu
- Hemotology Department, West China Hospital, Sichuan University, Chengdu, P. R. China.
| |
Collapse
|
5
|
Chojnowski K, Janus A, Bliźniewska K, Robak M, Treliński J. Long-lasting extreme anemia during the therapy of acute lymphoblastic leukemia in a Jehovah's Witness patient. Transfusion 2016; 56:2438-2442. [PMID: 27385671 DOI: 10.1111/trf.13703] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 05/23/2016] [Accepted: 05/23/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND The treatment of patients with acute leukemia, who due to their religious beliefs refuse to accept blood transfusion, is a great challenge for hematologists. CASE REPORT We present a case of acute pre-T-lymphoblastic leukemia in a Jehovah's Witness who did not accept blood transfusion during chemotherapy. Standard induction and consolidation chemotherapy was used (according to the PALG ALL-6 regiment). RESULTS During consolidation cycles, darbepoietin alfa, intravenous iron, and total parenteral nutrition was administered. Extreme (Hb < 5 g/dL), long-lasting (41 days) anemia was observed with the lowest Hb concentration amounting to 1.3 g/dL (lasting 7 days). CONCLUSION We believe this to be the lowest Hb value observed, particularly one that persisted for such a long period of time and resulted in the patient surviving without consequences. The patient remains in complete remission for more than 2 years after diagnosis.
Collapse
Affiliation(s)
| | - Agnieszka Janus
- Department of Hematology, Copernicus Memorial Hospital, Łódź, Poland
| | | | - Marta Robak
- Department of Hemostasis, Medical University of Łódź, and the, Łódź, Poland
| | - Jacek Treliński
- Department of Hemostasis, Medical University of Łódź, and the, Łódź, Poland.
| |
Collapse
|
6
|
A Jehovah's Witness with Acute Myeloid Leukemia Successfully Treated with an Epigenetic Drug, Azacitidine: A Clue for Development of Anti-AML Therapy Requiring Minimum Blood Transfusions. Case Rep Hematol 2014; 2014:141260. [PMID: 25371835 PMCID: PMC4202254 DOI: 10.1155/2014/141260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 09/23/2014] [Indexed: 11/17/2022] Open
Abstract
Therapy for acute leukemia in Jehovah's Witnesses patients is very challenging because of their refusal to accept blood transfusions, a fundamental supportive therapy for this disease. These patients are often denied treatment for fear of treatment-related death. We present the first Jehovah's Witness patient with acute myeloid leukemia (AML) treated successfully with azacitidine. After achieving complete remission (CR) with one course of azacitidine therapy, the patient received conventional postremission chemotherapy and remained in CR. In the case of patients who accept blood transfusions, there are reports indicating the treatment of AML patients with azacitidine. In these reports, azacitidine therapy was less toxic, including hematoxicity, compared with conventional chemotherapy. The CR rate in azacitidine-treated patients was inadequate; however, some characteristics could be useful in predicting azacitidine responders. The present case is useful for treating Jehovah's Witnesses patients with AML and provides a clue for anti-AML therapy requiring minimum blood transfusions.
Collapse
|
7
|
Cowan AJ, Altemeier WA, Johnston C, Gernsheimer T, Becker PS. Management of Acute Myeloid Leukemia in the Intensive Care Setting. J Intensive Care Med 2014; 30:375-84. [DOI: 10.1177/0885066614530959] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 12/16/2013] [Indexed: 01/18/2023]
Abstract
Patients with acute myeloid leukemia (AML) who are newly diagnosed or relapsed and those who are receiving cytotoxic chemotherapy are predisposed to conditions such as sepsis due to bacterial and fungal infections, coagulopathies, hemorrhage, metabolic abnormalities, and respiratory and renal failure. These conditions are common reasons for patients with AML to be managed in the intensive care unit (ICU). For patients with AML in the ICU, providers need to be aware of common problems and how to manage them. Understanding the pathophysiology of complications and the recent advances in risk stratification as well as newer therapy for AML are relevant to the critical care provider.
Collapse
Affiliation(s)
- Andrew J. Cowan
- Division of Hematology, University of Washington, Seattle, WA, USA
- Division of Medical Oncology, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | - William A. Altemeier
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA
| | - Christine Johnston
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Terry Gernsheimer
- Division of Hematology, University of Washington, Seattle, WA, USA
- Puget Sound Blood Center, Seattle, WA, USA
| | - Pamela S. Becker
- Division of Hematology, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| |
Collapse
|
8
|
Shortt J, Polizzotto MN, Waters N, Borosak M, Moran M, Comande M, Devine A, Jolley DJ, Wood EM. Assessment of the urgency and deferability of transfusion to inform emergency blood planning and triage: the Bloodhound prospective audit of red blood cell use. Transfusion 2009; 49:2296-303. [PMID: 19624492 DOI: 10.1111/j.1537-2995.2009.02305.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Careful planning is essential to ensure blood availability during shortages. Triaging supply is one proposed strategy; however, few data concerning the urgency of transfusion are available to inform planning. This study sought to determine the proportion of red blood cells (RBCs) used for clinically urgent indications. STUDY DESIGN AND METHODS A total of 5132 RBC units were randomly selected at point of production and distributed into general statewide inventory over a 9-month period. These selected units carried case report forms, for completion at the point of hospital issue for transfusion. Completed forms were returned to the blood service for collation and analysis, capturing information on indication and clinical urgency of supply, including use for potentially deferrable elective surgery. RESULTS Data from 5052 RBC units indicated that 95.6% were transfused. Approximately one-third of transfused units were used to support surgery, one-third for hematology/oncology, and one-third for other medical and miscellaneous indications. Where used for surgery, 25.7% (95% confidence interval [CI], 23.4%-28.0%) were for elective procedures, although urgency of surgery was unknown in 17.1% (95% CI, 15.2%-19.2%) of cases. Supply for nonurgent medical indications and elective surgery only accounted for 9.8% (95% CI, 9.0%-10.6%) of use, with 53.4% (95% CI, 52.0%-54.8%) of RBCs required within 24 hours. CONCLUSIONS The majority of RBCs are transfused with a high degree of clinical urgency, with only a minor proportion required to support elective surgery.
Collapse
Affiliation(s)
- Jake Shortt
- Transfusion Medicine Services, Australian Red Cross Blood Service, Australia
| | | | | | | | | | | | | | | | | |
Collapse
|