Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep 7;15(18):4462.
doi: 10.3390/cancers15184462.

Real-World Presentation and Prognostic Effect of Allogeneic Blood Transfusion during the Intensive Induction Phase in Pediatric Acute Lymphoblastic Leukemia

Kunyin Qiu  1   2 , Xiongyu Liao  1   2 , Yang Li  1   2 , Ke Huang  1   2 , Honggui Xu  1   2 , Jianpei Fang  1   2 , Dunhua Zhou  1   2
Affiliations

Real-World Presentation and Prognostic Effect of Allogeneic Blood Transfusion during the Intensive Induction Phase in Pediatric Acute Lymphoblastic Leukemia

Kunyin Qiu et al. Cancers (Basel). .

Abstract

Purpose: To determine associations between allogeneic blood transfusion (ABT) during the intensive induction phase of therapy and prognostic effect in a real-world cohort of pediatric patients with acute lymphoblastic leukemia (ALL). Methods: A total of 749 pediatric patients who were diagnosed with ALL were enrolled in this study by using a single-center retrospective cohort study method from February 2008 to May 2022. Results: Among the ABT patients, 711 (94.9%) children were transfused with packed red blood cells (PRBCs), 434 (57.9%) with single-donor platelets (SDPs), and 196 (26.2%) with fresh frozen plasma (FFP). Our multivariate analysis demonstrated that FFP transfusion was the unique independent factor that affected both relapse-free survival (RFS) and overall survival (OS). The transfusion of FFP was significantly associated with higher age (p < 0.001), being more likely to receive SCCLG-ALL-2016 protocol (p < 0.001), higher proportion of more than 25 blood product transfusions, more PRBC transfusion (p < 0.001), and higher D33-MRD-positive rates (p = 0.013). Generalized additive models and threshold effect analysis using piece-wise linear regression were applied to identify the cut-off value of 25 mL/kg for average FFP transfusion. K-M survival analysis further confirmed that average FFP transfusion > 25 mL/kg was an independent adverse indicator of inferior outcome in terms of RFS (p = 0.027) and OS (p = 0.033). Conclusions: In blood products, only FFP supplement is closely related to the prognosis of childhood ALL. During the intensive induction phase, the indications of FFP transfusion should be strictly grasped, and the total amount of FFP should be controlled and kept below 25 mL/kg.

Keywords: ABT; ALL; FFP; children; prognostic.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Survival curves of pediatric ALL patients according to whether patients received FFP transfusion and the threshold of average FFP transfusion. (A) Probability of RFS for patients with FFP transfusion and without FFP transfusion. (B) Probability of OS for patients with FFP transfusion and without FFP transfusion. (C) Probability of RFS for patients with different average FFP transfusions. (D) Probability of OS for patients with different average FFP transfusions.
Figure 1
Figure 1
Survival curves of pediatric ALL patients according to whether patients received FFP transfusion and the threshold of average FFP transfusion. (A) Probability of RFS for patients with FFP transfusion and without FFP transfusion. (B) Probability of OS for patients with FFP transfusion and without FFP transfusion. (C) Probability of RFS for patients with different average FFP transfusions. (D) Probability of OS for patients with different average FFP transfusions.
Figure 2
Figure 2
General additive models demonstrate the relationship between average FFP transfusion and the risk of relapse-free. The resulting figures show the predicted log (relative risk) on the y-axis and the average FFP transfusion on the x-axis.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Remy K.E., Hall M.W., Cholette J., Juffermans N.P., Nicol K., Doctor A., Blumberg N., Spinella P.C., Norris P.J., Dahmer M.K., et al. Mechanisms of red blood cell transfusion-related immunomodulation. Transfusion. 2018;58:804–815. doi: 10.1111/trf.14488. - DOI - PMC - PubMed
    1. Chao Y.H., Wu K.H. Transfusion-related immunomodulation in pediatric patients. Pediatr. Neonatol. 2019;60:483–484. doi: 10.1016/j.pedneo.2019.09.001. - DOI - PubMed
    1. Opelz G. Current relevance of the transfusion effect in renal transplantation. Transplant. Proc. 1985;17:1015–1021.
    1. Abdolmohammadi K., Mahmoudi T., Jafari-Koshki T., Hassan Z.M., Pourfathollah A.A. Immunomodulatory Effects of Blood Transfusion on Tumor Size, Metastasis, and Survival in Experimental Fibrosarcoma. Indian J. Hematol. Blood Transfus. 2018;34:697–702. doi: 10.1007/s12288-018-0962-9. - DOI - PMC - PubMed
    1. Yu E.W., Gao L., Stastka P., Cheney M.C., Mahabamunuge J., Torres Soto M., Ford C.B., Bryant J.A., Henn M.R., Hohmann E.L. Fecal microbiota transplantation for the improvement of metabolism in obesity: The FMT-TRIM double-blind placebo-controlled pilot trial. PLoS Med. 2020;17:e1003051. doi: 10.1371/journal.pmed.1003051. - DOI - PMC - PubMed

LinkOut - more resources