Blood Res.  2013 Jun;48(2):133-138. 10.5045/br.2013.48.2.133.

Prognostic effect of blood transfusion in children with acute lymphoblastic leukemia

• Alkayed K
• Al Hmood A
• Madanat F

• KMID: 2172912
• DOI: http://doi.org/10.5045/br.2013.48.2.133

Abstract

BACKGROUND
Most children with acute lymphoblastic leukemia (ALL) receive blood transfusions. Transfusions may affect ALL outcomes through transfusion-related immunomodulation (TRIM).
METHODS
We analyzed overall survival (OS) and event-free survival (EFS) in relation to leukocyte reduced and irradiated (LR/IRR) blood products transfused during the induction phase in 136 children with ALL. Hazard ratios (HRs) for death and relapse were estimated through Cox regression analysis.
RESULTS
One hundred and twenty patients (89%) were transfused with packed red blood cells (PRBCs) and 79 (58%) with single donor platelets (SDPs). The median number of transfusions was 2 (interquartile range [IQR]=1-3 events) and 1 (IQR=0-3 events) for PRBCs and SDPs, respectively. Patients who had white blood cell (WBC) count >50,000x10(9)/L, were classified as high risk according to the high National Cancer Institute criteria, displayed a T cell phenotype, or were minimal residual disease-positive at end of induction were more likely to receive >3 transfusions during induction (P=0.001, 0.002, 0.03, and 0.01, respectively). In univariate analysis, PRBC, SDP, and fresh frozen plasma transfusions did not have any significant association with relapse or death. For PRBC transfusions, the HRs for EFS and OS were 1.02 (95% CI, 0.85-1.24; P=0. 76) and 1.03 (95% CI, 0.83-1.27; P=0.76), respectively. For SDP transfusions, HRs were 1.03 (95% CI, 0.90-1.18; P=0.64) and 0.98 (95% CI, 0.80-1.20; P=0.87) for EFS and OS, respectively.
CONCLUSION
LR/IRR blood products may not confer a TRIM effect in childhood ALL and are unlikely to affect outcome.

Keyword

Acute lymphoblastic leukemia; Blood transfusion; Prognosis

MeSH Terms

Blood Platelets
Blood Transfusion
Child
Disease-Free Survival
Erythrocytes
Humans
Immunomodulation
Leukocytes
National Cancer Institute (U.S.)
Phenotype
Plasma
Polymethacrylic Acids
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Prognosis
Recurrence
Tissue Donors
Polymethacrylic Acids

Figure

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  Fig. 1 Kaplan-Meier analysis of event-free survival according to the number of transfusion events during induction.

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  Fig. 2 Kaplan-Meier analysis of overall survival according to the number of transfusion events during induction.

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