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Stanworth SJ, Killick S, McQuilten ZK, Karakantza M, Weinkove R, Smethurst H, Pankhurst LA, Hodge RL, Hopkins V, Thomas HL, Deary AJ, Callum J, Lin Y, Wood EM, Buckstein R, Bowen D, Wallis L, Rabbi T, Serrano M, Williams R, Chacko J, Darlow J, Watson L, Earley K, Haas N, Woods L, Dimitriu C, Croft J, Carvalhosa A, Clarke C, Hickish T, Penny C, Sternberg A, Owen T, Parajes C, Meyer C, Dodge J, Meakin S, Lake D, Culligan D, Fletcher H, Forbes H, Johannesson N, Taylor G, Tomlinson J, Shaw A, Ratcliffe M, Lamacchia M, Vickers M, Duncan C, Untiveros P, Olaiya A, Tighe J, Preston G, Zaidi M, Lawrie A, Robertson C, Saadi H, Onyeakazi U, Radia R, Father T, Stainthorp K, Mc Connell S, Booth T, Langton C, Howcroft C, Saddiq I, Gupta ED, Byrne J, Lindsey‐Hill J, Badder D, Jones M, Pol R, Vyas P, Mead A, Peniket A, Bancroft R, Springett S, Yoganayagam S, Gray L, Friesen H, Wardle K, Murthy V, Pratt G, Kishore B, Mayer G, Nikolousis E, Smith N, Lovell R, Kartsios C, Ewing J, Lumley M, Khawaja J, Ali M, Sutton D, Murray D, Milligan D, Dhani S, O'Sullivan M, Whitehouse J, Schumacher A, Enstone R, Hardy A, Kelly M, Wallis J, Boal L, Davies M, Latter R, Wincup J, Ellis S, Poolan S, Birt M, Watts E, Charlton A, Forsyth H, Waring L, Twohig J, Marr H, Lennard A, Jones G, Menne T, Redding N, Jones S, Robinson K, Grand E, Cullis J, Collins F, Gamble L, Brown J, Tudgay S, Salisbury S, Mathew S, Tipler N, Parker T, Stobie E, Tribbeck M, Hebballi S, Millar C, Allotey D, Lala J, McGee N, Chmeil J, Hufton L, Dawson S, Weincove R, Smyth D, Buyck H, Hayden J, George A, Baluwala I, Wheeler M, Daysh L, Williams O, Millmow S, Miles R, Geller S, Blakemore M, Hargreaves A, Hayden G, Mo A, Van Dam M, Uhe M, Indran T, Wong J, Coughlin L, MacWhannell A, Beardsmore C, Lunn L, Pearson S, Shaw S, Parker J, Bowen A, Jones A, Player M. Red cell transfusion in outpatients with myelodysplastic syndromes: a feasibility and exploratory randomised trial. Br J Haematol 2020; 189:279-290. [PMID: 31960409 DOI: 10.1111/bjh.16347] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/06/2019] [Indexed: 01/05/2023]
Abstract
Optimal red cell transfusion support in myelodysplastic syndromes (MDS) has not been tested and established. The aim of this study was to demonstrate feasibility of recruitment and follow-up in an outpatient setting with an exploratory assessment of quality of life (QoL) outcomes (EORTC QLQ-C30 and EQ-5D-5L). We randomised MDS patients to standardised transfusion algorithms comparing current restrictive transfusion thresholds (80 g/l, to maintain haemoglobin 85-100 g/l) with liberal thresholds (105 g/l, maintaining 110-125 g/l). The primary outcomes were measures of compliance to transfusion thresholds. Altogether 38 patients were randomised (n = 20 restrictive; n = 18 liberal) from 12 participating sites in UK, Australia and New Zealand. The compliance proportion for the intention-to-treat population was 86% (95% confidence interval 75-94%) and 99% (95-100%) for restrictive and liberal arms respectively. Mean pre-transfusion haemoglobin concentrations for restrictive and liberal arms were 80 g/l (SD6) and 97 g/l (SD7). The total number of red cell units transfused on study was 82 in the restrictive and 192 in the liberal arm. In an exploratory analysis, the five main QoL domains were improved for participants in the liberal compared to restrictive arm. Our findings support the feasibility and need for a definitive trial to evaluate the effect of different red cell transfusion thresholds on patient-centred outcomes.
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Affiliation(s)
- Simon J. Stanworth
- Oxford University Oxford United Kingdom
- The John Radcliffe Hospital Oxford GBR
- NHSBT Oxford United Kingdom
| | - Sally Killick
- The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust Bournemouth United Kingdom
| | | | - Marina Karakantza
- Department of HaematologyLeeds Teaching Hospitals Leeds United Kingdom
| | - Robert Weinkove
- Wellington Blood & Cancer CentreCapital & Coast District Health Board Wellington New Zealand
- Malaghan Institute of Medical Research Wellington New Zealand
| | - Heather Smethurst
- NHS Blood and Transplant Clinical Trials Unit Cambridge United Kingdom
| | | | - Renate L. Hodge
- NHS Blood and Transplant Clinical Trials Unit Cambridge United Kingdom
| | - Valerie Hopkins
- NHS Blood and Transplant Clinical Trials Unit Cambridge United Kingdom
| | - Helen L. Thomas
- NHS Blood and Transplant Clinical Trials Unit Bristol United Kingdom
| | - Alison J. Deary
- NHS Blood and Transplant Clinical Trials Unit Cambridge United Kingdom
| | - Jeannie Callum
- Department of Laboratory Medicine and Molecular DiagnosticsSunnybrook Health Sciences Centre Toronto ON Canada
- Department of Laboratory Medicine and PathobiologyUniversity of Toronto Toronto ON Canada
| | - Yulia Lin
- Department of Laboratory Medicine and Molecular DiagnosticsSunnybrook Health Sciences Centre Toronto ON Canada
- Department of Laboratory Medicine and PathobiologyUniversity of Toronto Toronto ON Canada
| | - Erica M. Wood
- Transfusion Research UnitMonash University Melbourne Australia
| | - Rena Buckstein
- Odette Cancer CentreSunnybrook Health Sciences Centre Toronto ON Canada
| | - David Bowen
- Department of HaematologyLeeds Teaching Hospitals Leeds United Kingdom
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