Large-scale UK audit of blood transfusion requirements and anaemia in patients receiving cytotoxic chemotherapy

Barrett-Lee, Peter; Bailey, N; O’Brien, Mary; Wager, Elizabeth

doi:10.1054/bjoc.1999.0883

Cited by 147 publications

(88 citation statements)

References 4 publications

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“…These findings indicate the important prognostic value of the pre-treatment Hb level for the risk of developing transfusion dependent anaemia, as reported by other investigators (Manegold, 1998;Groopman and Itri, 1999;Barrett-Lee et al, 2000). With the higher number of transfusions given, the potential side effects of RBC transfusions, such as viral infections, haemolysis, immunological or anaphylactic reactions may contribute to the risk associated with the treatment in this young patient population (Groopman and Itri, 1999;Mercadante et al, 2000).…”

Section: Discussionsupporting

confidence: 81%

“…Another trial demonstrated a correlation between Hb levels during chemotherapy and response to therapy. This investigation has included patients with different types of solid tumours (Barrett-Lee et al, 2000).…”

Section: Discussionmentioning

confidence: 99%

“…The cumulative risk of receiving red blood cell (RBC) transfusions in patients who are treated with 4 -6 cycles of conventional cisplatin-based combination chemotherapy is approximately 60% (Manegold, 1998;Barrett-Lee et al, 2000;Pivot et al, 2000). RBC transfusions may be associated with adverse effects such as viral infections, e.g.…”

mentioning

confidence: 99%

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Treatment-induced anaemia and its potential clinical impact in patients receiving sequential high dose chemotherapy for metastatic testicular cancer

et al. 2002

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First-line sequential high dose chemotherapy is under investigation in patients with 'poor prognosis' metastatic germ cell tumours in order to improve survival. Despite the use of autologous peripheral blood stem cell transplantation and granulocyte colony stimulating factor chemotherapy dose intensification is associated with severe haematotoxicity including anaemia, which may significantly affect quality of life and tolerability of chemotherapy. This study investigates the frequency and degree of anaemia in patients receiving first-line sequential high dose chemotherapy for metastatic testicular cancer and the impact of anaemia on treatment outcome. A total of 101 newly diagnosed patients with 'poor prognosis' metastatic nonseminomatous germ cell tumours were treated with one cycle of standard VIP followed by three cycles of HD-VIPchemotherapy (etoposide, ifosfamide, cisplatin) within a large phase I/II study. Differential blood cell counts were taken prior, during and after every cycle of chemotherapy. Additionally, the numbers of red blood cell and platelet transfusions were recorded. Kaplan -Meier analyses were performed to correlate pre-treatment and post-treatment haemoglobin values to response and overall survival. Forty-eight per cent of the patients were classified anaemic (haemoglobin 512 g dl 71 ) prior to the start of chemotherapy. The application of sequential HD-VIP resulted in median haemoglobin nadirs between 7.8 g dl 71 (range 5.5 -11.1 g dl 71 ) in the first cycle and 7.6 g dl 71 (range 6.0 -11.4 g dl 71 ) in the third cycle despite the frequent use of red blood cell transfusions. Almost all patients (99%) had haemoglobin levels 510 g dl 71 at some timepoint during first-line sequential high dose chemotherapy. Overall, 97 patients received red blood cell transfusions with a median of 10 units (range 2 -25) per patient during the four consecutive cycles of therapy. The time to first transfusion was shortest in patients with the lowest initial haemoglobin values. While there was no prediction of response or outcome by baseline haemoglobin-levels, a significant survival difference in favour of patients with a haemoglobin value 410.5 g dl 71 after completion of four cycles of therapy (at leukocyte recovery after the last cycle) compared to those with haemoglobin values 510.5 g dl 71 was found with 3-year overall survival rates of 87% vs 68%, respectively (P50.05). Severe anaemia is a very frequent side effect of sequential dose intensive therapy in patients with germ cell cancer, with almost all patients becoming transfusion dependent. Despite the frequent use of red blood cell transfusions, median haemoglobin nadirs remained about 7.5 -8 g dl 71 during therapy. A correlation of haemoglobin-values after completion of therapy to overall treatment outcome was found.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

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Treatment-induced anaemia and its potential clinical impact in patients receiving sequential high dose chemotherapy for metastatic testicular cancer

et al. 2002

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“…The chief aim of transfusion is to immediately correct the signs or symptoms resulting from anemia (Barrett-Lee et al, 2000). However, there is evidence in the literature that blood transfusion may have a negative impact on the progression of disease.…”

Section: Introductionmentioning

confidence: 99%

Use of Blood Transfusion at the End of Life: Does it Have Any Effects on Survival of Cancer Patients?

Göksu¹,

Gündüz²,

Ünal³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: Treatment of anemia is an important issue in the palliative care setting. Blood transfusion is generally used for this purpose in supportive care. However the place of blood transfusion in terminally ill cancer cases is less far established. Objective: We aimed to outline the use of transfusions and to find the impact of blood transfusion on survival in patients with advanced cancer and very near to death. Design: Patients dying in 2010-2011 with advanced cancer were included in the study. We retrospectively collected the data including age, type of cancer, the duration of last hospitalisation, ECOG performance status, Hb levels, transfusion history of erythrocytes and platelets, cause and the amount of transfusion. The anaemic patients who had transfusion at admission were compared with the group who were not transfused. Survival was defined as the time between the admission of last hospitalisation period and death. Results: Three hundred and ninety eight people with solid tumours died in 2010-2011 in our clinic. Ninety percent of the patients had anemia at the time of last hospitalisation. One hundred fifty three patients had erythrocyte transfusion at admission during the last hospitalisation period (38.4%). In the anaemic population the duration of last hospitalisation was longer in patients who had erythrocyte transfusion (15 days vs 8 days, p<0.001). Conclusions: Patients who had blood transfusion at the end of life lived significantly longer than the anaemic patients who were not transfused. This study remarks that blood transfusions should not be withheld from terminal cancer patients in palliative care.

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“…A low baseline Hb level has consistently been identified as a prominent factor associated with the likelihood of future transfusion [18][19][20][21][22][23][24][27][28][29][30]. A recent meta-analysis, which assessed the predictors of transfusion, pointed to the observation that prior RBC transfusion in cancer patients increases the risk for subsequent transfusions, with or without the use of epoetin alfa [31].…”

Section: Introductionmentioning

confidence: 99%

Patients Previously Transfused or Treated with Epoetin Alfa at Low Baseline Hemoglobin Are at Higher Risk for Subsequent Transfusion: An Integrated Analysis of the Canadian Experience

et al. 2006

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After completing this course, the reader will be able to:1. Identify chemotherapy patients at risk of transfusion by carefully monitoring hemoglobin levels and prior incidence of transfusion.2. Define the optimal Hb target at which epoetin alfa treatment should be initiated to minimize subsequent transfusion need.3. Understand that more than 85% of units transfused occurred in patients receiving epoetin alfa with baseline Hb <10g/dl and evaluate the clinical impact of early treatment initiation. AbstractBackground. The introduction of recombinant human erythropoietin to the management of anemia in cancer patients has resulted in significant reductions in allogeneic blood transfusions, while at the same time contributing to improvements in quality of life. A recent metaanalysis of five randomized, placebo-controlled trials with patient-level data revealed that, while epoetin alfa was very effective in reducing transfusions compared with placebo, patients who were pretransfused were twice as likely to subsequently be transfused during epoetin alfa treatment.

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Large-scale UK audit of blood transfusion requirements and anaemia in patients receiving cytotoxic chemotherapy

Cited by 147 publications

References 4 publications

Treatment-induced anaemia and its potential clinical impact in patients receiving sequential high dose chemotherapy for metastatic testicular cancer

Treatment-induced anaemia and its potential clinical impact in patients receiving sequential high dose chemotherapy for metastatic testicular cancer

Use of Blood Transfusion at the End of Life: Does it Have Any Effects on Survival of Cancer Patients?

Patients Previously Transfused or Treated with Epoetin Alfa at Low Baseline Hemoglobin Are at Higher Risk for Subsequent Transfusion: An Integrated Analysis of the Canadian Experience

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