Impact of red blood cell transfusion dose density on progression-free survival in lower-risk myelodysplastic syndromes patients.

Fecha de publicación: 01/03/2020 Fecha Ahead of Print: 06/06/2019

Autores de IIS La Fe

Guillermo Sanz Santillana

Autor

Participantes ajenos a IIS La Fe

de Swart L
Crouch S
Hoeks M
Smith A
Langemeijer S
Fenaux P
Symeonidis A
Cermák J
Hellström-Lindberg E
Stauder R
Mittelman M
Holm MS
Malcovati L
Madry K
Germing U
Tatic A
Savic A
Almeida AM
Gredelj-Šimec N
Guerci-Bresler A
Beyne-Rauzy O
Culligan D
Kotsianidis I
Itzykson R
van Marrewijk C
Blijlevens N
Bowen D
de Witte T
EUMDS Registry Participants

Grupos

Hematología y Hemoterapia

Investigador Principal

Javier De La Rubia Comos

Abstract

Progression-free survival of lower-risk myelodysplastic syndromes patients treated with red blood cell transfusions is usually reduced, but it is unclear whether transfusion dose density is an independent prognostic factor. The European MDS Registry collects prospective data at 6-monthly intervals of newly diagnosed lower-risk myelodysplastic syndromes patients from 16 European countries and Israel. Data on the transfusion dose density - the cumulative dose received at the end of each interval divided by the time since the beginning of the interval in which the first transfusion was received - were analyzed using proportional hazards regression with time-varying co-variates, with death and progression to higher-risk myelodysplastic syndromes /acute myeloid leukemia as events. Of the 1267 patients included in the analyses, 317 patients died without progression, in 162 patients the disease had progressed. Progression-free survival was significantly associated with age, EQ-5D index, baseline WHO classification, bone marrow blast count, cytogenetic risk category, number of cytopenias, and country. Transfusion dose density was inversely associated with progression-free survival (p1x10-4): dose density had an increasing effect on hazard until a dose density of 3 units/16 weeks. The transfusion dose density effect continued to increase beyond 8 units/16 weeks after correction for the impact of treatment with erythropoietin agents, lenalidomide and/or iron chelators. Conclusion: the negative effect of transfusion treatment on progression-free survival already occurs at transfusion densities below 3 units/16 weeks. This indicates that transfusion dependency, even at relatively low dose densities, may be considered as an indicator of inferior progression-free survival. This trial was registered at www.clinicaltrials.gov as #NCT00600860.

Datos de la publicación

ISSN/ISSNe:: 0390-6078, 1592-8721
Tipo:: Article
Páginas:: 632-639
DOI:: 10.3324/haematol.2018.212217
Factor de Impacto:: 2,782 SCImago ℠
Cuartil:: Q1 SCImago ℠

Documentos

No hay documentos

Métricas

Filiaciones

de Swart L:: Department of Hematology, Radboud university medical center, Nijmegen, The Netherlands
Crouch S:: Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, UK
Hoeks M:: Department of Hematology, Radboud university medical center, Nijmegen, The Netherlands
Smith A:: Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, UK
Langemeijer S:: Department of Hematology, Radboud university medical center, Nijmegen, The Netherlands
Fenaux P:: Service Hematologie Seniors, Hôpital Saint-Louis / Université Paris 7, France
Symeonidis A:: Department of Medicine, Division of Hematology, University of Patras Medical School, Patras, Greece
Cermák J:: Department of Clinical Hematology, Inst. of Hematology Blood Transfusion, Praha,Czech Republic
Hellström-Lindberg E:: Department of Medicine, Division of Hematology, Karolinska Institutet, Stockholm, Sweden
Stauder R:: Department of Haematology and Oncology, Innsbruck Medical University, Innsbruck, Austria
Sanz G:: Department of Haematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
Mittelman M:: Department of of Medicine A, Tel Aviv Sourasky (Ichilov) Medical Center, Tel Aviv, Israel
Holm MS:: Department of Haematology, Aarhus University Hospital, Aarhus, Denmark
Malcovati L:: Dept. of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
Madry K:: Department of Haematology, Oncology and Internal Medicine, Warszawa Medical University, Poland
Germing U:: Dept. of Hematology, Oncology Clinical Immunology, Universitätsklinik Dusseldorf, Germany
Tatic A:: Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania
Savic A:: Clinical Center of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
Almeida AM:: Department of Clinical Hematology, Hospital da Luz, Lisbon, Portugal
Gredelj-Šimec N:: Dept. of Internal Medicine, Division of Hematology, Merkur University Hospital, Zagreb, Croatia
Guerci-Bresler A:: Service Hematologie, Centre Hospitalier Universitaire Brabois Vandoeuvre, Nancy, France
Beyne-Rauzy O:: Service de Medecine Interne, IUCT-Oncopole, CHU Toulouse, France
Culligan D:: Department of Haematology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
Kotsianidis I:: Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
Itzykson R:: Service Hematologie Seniors, Hôpital Saint-Louis / Université Paris 7, France
van Marrewijk C:: Department of Hematology, Radboud university medical center, Nijmegen, The Netherlands
Blijlevens N:: Department of Hematology, Radboud university medical center, Nijmegen, The Netherlands
Bowen D:: St. James Institute of Oncology, Leeds Teaching Hospitals, Leeds, United Kingdom
de Witte T:: Nijmegen Center for Molecular Life Sciences, Radboud university medical center, The Netherland