Assessment of transfusion requirements of allogeneic haematopoietic stem cell transplantation recipients and factors influencing it

Introduction. Allogeneic haematopoietic stem cell transplantation (HSCT) is actively used in clinical practice for the treatment of various diseases. Recipients of allogeneic HSCT require significant amounts of transfusion therapy, but the real need for transfusions and factors influencing this need have not been assessed in domestic practice.

Materials and methods. A retrospective analysis of the need for transfusions of blood components of recipients of the first allogeneic HSCT performed in 2018–2022 during the observation period of 1 year was performed. The volumes of transfusions performed were calculated for each type of blood components. The transfusion-dependent period is represented by the number of days until the transfusion independence criteria were reached. The incidence of loss of transfusion independence is presented. The influence of various factors on transfusion requirement and transfusion independence was assessed.

Results and discussion. The median number of red blood cells transfusions was 2 (IQR 1–4), the median number of platelet transfusions was 5 (IQR 3–10). The only factor that influenced the volume of transfusion therapy was the type of diagnosis more transfusions were required for nonmalignant diseases. The duration of the transfusion-dependent period was influenced by the type of diagnosis, haematopoietic stem cell source and donor type. Gender differences between donor and recipient, as well as differences in ABO and conditioning regime did not influence either transfusion requirement or independence from transfusions.

Conclusion. This analysis presents the need for transfusions of donor blood components in allogeneic HSCT recipients during 1 year.

The results of the analysis can be used for planning the activities of transplantation centres and blood service institutions to provide transfusion support for HSCT recipients.

1. Milkins C., Berryman J., Cantwell C., Elliott C., Haggas R., Jones J., Rowley M., Williams M., Win N. Guidelines for pretrnafusion compatibility procedures in blood transfusion laboratories. Transfus Med. 2013;23:3–35. doi: 10.1111/j.1365-3148.2012.01199.x.

2. Adkins B.D., Booth G.S., Vasu S. Transfusion support for stem cell transplant recipients. Semin Hematol. 2020;57:51–6. doi: 10.1053/j.seminhematol.2020.07.001.

3. Morishima Y., Kashiwase K., Matsuo K., Azuma F., Morishima S., Onizuka M., Yabe T., Murata M., Doki N., Eto T., Mori T., Miyamura K., Sao H., Ichinohe T., Saji H., Kato S., Atsuta Y., Kawa K., Kodera Y., Sasazuki T.; Japan Marrow Donor Program. Biological signifi cance of HLA locus matching in unrelated donor bone marrow transplantation. Blood. 2015;125:1189–97. doi: 10.1182/blood-2014-10-604785.

4. Rowley S.D. Hematopoietic stem cell transplantation between red cell incompatible donor-recipient pairs. Bone Marrow Transplant. 2001;28(4):315–21. doi: 10.1038/sj.bmt.1703135. PMID: 11571501.

5. Cohn C.S. Transfusion support issues in hematopoietic stem cell transplantation. Cancer Control. 2015;22(1):52–9. doi: 10.1177/107327481502200108. PMID: 25504279.

6. Warner M.A., Jambhekar N.S., Saadeh S., Jacob EK., Kreuter J.D., Mundell W.C., Marquez A., Higgins A.A., Madde N.R., Hogan W.J., Kor D.J. Implementation of a patient blood management program in hematopoietic stem cell transplantation. Transfusion. 2019;59:2840–8. doi: 10.1111/trf.15414.

7. Datta S.S., Basu S., Chandy M. An analysis of transfusion support in haematopoietic stem cell transplantation – report from a centre in India. Transfus Apher Sci. 2015;53(3):373–7. doi: 10.1016/j.transci.2015.07.006. Epub 2015 Aug 18. PMID: 26321099.

8. Griffi th L.M., VanRaden M., Barrett A.J., Childs R.W., Fowler D.H., Kang E.M., Tisdale J.F., Klein H.G., Stroncek D.F. Transfusion support for matched sibling allogeneic hematopoietic stem cell transplantation (1993–2010): factors that predict intensity and time to transfusion independence. Transfusion. 2019;59(1):303–15. doi: 10.1111/trf.14966. Epub 2018 Oct 26. PMID: 30362577; PMCID: PMC6322947.

9. Kim H., Ko D.H. Transfusion in ABO-incompatible solid organ transplantation. Korean J Blood Transfus. 2020;31:70–2. doi: 10.17945/kjbt.2020.31.1.7.

10. Gajewski J.L., Johnson V.V., Sandler S.G., Sayegh A., Klumpp T.R. A review of transfusion practice before, during, and after hematopoietic progenitor cell transplantation. Blood. 2008;112(8):3036–47. doi: 10.1182/blood-2007-10-118372. Epub 2008 Jun 26. PMID: 18583566; PMCID: PMC2569162.

11. Akselrod B.A., Balashova E.N., Bautin A.E., Bakhovadinov B.B., Biryukova L.S., Bulanov A.Yu., Bystrykh O.A., Vinogradova M.A., Galstyan G.M., Gaponova T.V., Golovkina L.L., Gorokhovskiy V.S., Eremenko A.A., Zhiburt E.B., Zhuravel S.V., Kokhno A.V., Kuzmina L.A., Kulabukhov V.V., Kupryashov A.A., Lubnin A.Yu., Mazurok V.A., Menshugin I.N., Mineeva N.V., Mihailova E.A., Nikitin E.A., Olovnikova N.I., Oshorov A.V., Pevtsov D.E., Poptsov V.N., Rogachevskiy O.V., Salimov E.L., Titkov K.V., Trakhtman P.E., Troitskaya V.V., Fedorova T.A., Fidarova Z.T., Tsvetaeva N.V., Chzhao A.V., Shestakov E.F. Clinical guidelines for red blood cell transfusion. Gematologiya i transfuziologiya = Russian journal of hematology and transfusiology. 2018;63(4):372–435. (In Russ.).

12. Balashov D.N., Trakhtman P.E. Features of transfusion therapy in patients undergoing hematopoietic stem cell transplantation. Review of the literature. Onkogematologiya = Oncohematology. 2013;8(3):42–7. (In Russ.).

13. Wang Z., Sorror M.L., Leisenring W., Schoch G., Maloney D.G., Sandmaier B.M., Storb R. The impact of donor type and ABO incompatibility on transfusion requirements after nonmyeloablative haematopoietic cell transplantation. Br J Haematol. 2010;149(1):101–10. doi: 10.1111/j.1365-2141.2009.08073.x. Epub 2010 Jan 11. PMID: 20067562; PMCID: PMC2864362.

14. Tay J., Allan D.S., Chatelain E., Coyle D., Elemary M., Fulford A., Petrcich W., Ramsay T., Walker I., Xenocostas A., Tinmouth A., Fergusson D. Liberal versus restrictive red blood cell transfusion thresholds in hematopoietic cell transplantation: a randomized, open label, phase III, noninferiority trial. J Clin Oncol. 2020;38(13):1463–73. doi: 10.1200/JCO.19.01836. Epub 2020 Feb 21. PMID: 32083994.

15. Robitaille N., Lacroix J., Alexandrov L., Clayton L., Cortier M., Schultz K.R., Bittencourt H., Duval M. Excess of veno-occlusive disease in a randomized clinical trial on a higher trigger for red blood cell transfusion after bone marrow transplantation: a canadian blood and marrow transplant group trial. Biol Blood Marrow Transplant. 2013;19(3):468–73. doi: 10.1016/j.bbmt.2012.12.002. Epub 2012 Dec 7. PMID: 23220014.

16. Hosoba S., Waller E.K., Shenvi N., Graiser M., Easley K.A., Al-Kadhimi Z., Andoh A., Antun A.G., Barclay S., Josephson C.D., Koff J. L., Jean Khoury H., Langston A.A., Zimring J.C., Roback J.D., Giver C.R. Peritransplantation red blood cell transfusion is associated with increased risk of graft-versus-host disease after allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2018;24:973–82. doi: 10.1016/j.bbmt.2018.01.003.

17. Schrezenmeier H., Körper S., Höchsmann B., Weinstock C., Carreras E., Dufour C., Mohty M., Kröger N., eds. Transfusion support. In: The EBMT Handbook: Hematopoietic Stem Cell Transplantation and Cellular Therapies [Internet]. 7th ed. Cham (CH): Springer, 2019. Chapter 23. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553976/. doi: 10.1007/978-3-030-02278-5_23.

18. Jekarl D.W., Kim J.K., Han J.H., Lee H., Yoo J., Lim J., Kim Y. Transfusion support in hematopoietic stem cell transplantation. Blood Res. 2023;58(S1):S1–7. doi: 10.5045/br.2023.2023004. Epub 2023 Feb 27. PMID: 36843378; PMCID: PMC10133853.

19. Fung M., Eder A.F., Spitalnik S.L., Westhoff C.M. Technical manual. 19th ed. Bethesda, MD: AABB Press, 2017. Pp. 683–91.

20. Woo K.S., Kim J.E., Kim K.E., Kim J.M., Han J.Y., Kim S.H., Kim K.H. Eff ect of ABO-incompatibility on allogeneic hematopoietic stem cell transplantation. A single institute study. Korean J Blood Transfus. 2009;20:235–41. doi: 10.32388/uqy1gr.

21. Solves P., Carpio N., Carretero C., Lorenzo J.I., Sanz J., Gómez I., López-Chuliá F., Arilla M.J., Regadera A.I., Montesinos P., Sanz G.F., Sanz M.Á. ABO incompatibility does not infl uence transfusion requirements in patients undergoing single-unit umbilical cord blood transplantation. Bone Marrow Transplant. 2017;52(3):394–9. doi: 10.1038/bmt.2016.264. Epub 2016 Oct 31. PMID: 27797368.

22. Ojha S., Patle V., Nagaraju P., Khattry N. Blood components utilization in hematopoietic stem cell transplantation: Thirteen-year analysis from an apex oncology center of India. Asian J Transfus Sci. 2023;17(2):221–8. doi: 10.4103/ajts.ajts_12_22.

23. Yuan S., Yang D., Nakamura R., Zhuang L., Al Malki M.M., Wang S. RBC and platelet transfusion support in the fi rst 30 and 100 days after haploidentical hematopoietic stem cell transplantation. Transfusion. 2019;59(11):3371–85. doi: 10.1111/trf.15531. Epub 2019 Oct 10. PMID: 31599972.

24. Weissinger F., Sandmaier B.M., Maloney D.G., Bensinger W.I., Gooley T., Storb R. Decreased transfusion requirements for patients receiving nonmyeloablative compared with conventional peripheral blood stem cell transplants from HLA-identical siblings. Blood. 2001;98(13):3584–8. doi: 10.1182/blood.v98.13.3584. PMID: 11739160.

25. Ivanov V., Faucher C., Mohty M., Bilger K., Ladaique P., Sainty D., Arnoulet C., Chabannon C., Vey N., Camerlo J., Bouabdallah R., Maraninchi D., Bardou V.J., Blaise D. Decreased RBCTs after reduced intensity conditioning allogeneic stem cell transplantation: predictive value of prior Hb level. Transfusion. 2004;44(4):501–8. doi: 10.1111/j.1537-2995.2004.03317.x. PMID: 15043564.

26. Liesveld J., Pawlowski J., Chen R., Hyrien O., Debolt J., Becker M., Phillips G. 2nd, Chen Y. Clinical factors aff ecting engraftment and transfusion needs in SCT: a single-center retrospective analysis. Bone Marrow Transplant. 2013;48(5):691–7. doi: 10.1038/bmt.2012.194. Epub 2012 Oct 22. PMID: 23085827.