Annals of Hematology

, Volume 94, Issue 11, pp 1797–1806 | Cite as

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

  • Giovanna Cannas
  • Jihane Fattoum
  • Michel Raba
  • Hélène Dolange
  • Gregory Barday
  • Marion François
  • Mohamed Elhamri
  • Gilles Salles
  • Xavier Thomas
Original Article
First Online:
Received:
Accepted:

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.

Keywords

Acute myeloid leukemia Transfusion dependency Transfusion intensity Prognosis Chemotherapy 
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Notes

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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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Giovanna Cannas
    • 1
  • Jihane Fattoum
    • 2
  • Michel Raba
    • 3
  • Hélène Dolange
    • 1
  • Gregory Barday
    • 3
  • Marion François
    • 3
  • Mohamed Elhamri
    • 2
  • Gilles Salles
    • 2
  • Xavier Thomas
    • 2
  1. 1.Hemovigilance Department, Hospices Civils de LyonEdouard Herriot and Croix-Rousse HospitalsLyonFrance
  2. 2.Hematology Department, Hospices Civils de LyonLyon-Sud HospitalPierre BéniteFrance
  3. 3.Etablissement Français du SangBlood Bank CenterLyonFrance

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