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Transfusion dependency at diagnosis and transfusion intensity during initial chemotherapy are associated with poorer outcomes in adult acute myeloid leukemia

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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.

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Conflict of interest

All authors declare no conflict of interest.

Authors’ contributions

GC collected the transfusion data, interpreted the data, and wrote the manuscript. JF, MR, HD, GB, and MF collected the transfusion data. ME collected the patient data and provided technical support. GS reviewed the manuscript and gave final approval. XT interpreted the data, performed statistical analyses, and wrote the manuscript.

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Authors and Affiliations

  1. Hemovigilance Department, Hospices Civils de Lyon, Edouard Herriot and Croix-Rousse Hospitals, Lyon, France

    Giovanna Cannas & Hélène Dolange

  2. Hematology Department, Hospices Civils de Lyon, Lyon-Sud Hospital, 165 chemin du Grand Revoyet, 69495, Pierre Bénite, France

    Jihane Fattoum, Mohamed Elhamri, Gilles Salles & Xavier Thomas

  3. Etablissement Français du Sang, Blood Bank Center, Lyon, Rhône-Alpes, France

    Michel Raba, Gregory Barday & Marion François

Authors
  1. Giovanna Cannas
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  2. Jihane Fattoum
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  4. Hélène Dolange
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  5. Gregory Barday
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  6. Marion François
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  8. Gilles Salles
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  9. Xavier Thomas
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Correspondence to Xavier Thomas.

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Cannas, G., Fattoum, J., Raba, M. et al. Transfusion dependency at diagnosis and transfusion intensity during initial chemotherapy are associated with poorer outcomes in adult acute myeloid leukemia. Ann Hematol 94, 1797–1806 (2015). https://doi.org/10.1007/s00277-015-2456-2

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  • DOI: https://doi.org/10.1007/s00277-015-2456-2

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