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. 2023 Apr 13;50(5):456-468.
doi: 10.1159/000529595. eCollection 2023 Oct.

Defining Current Patterns of Blood Product Use during Intensive Induction Chemotherapy in Newly Diagnosed Acute Myeloid Leukemia Patients

Liron Miller  1 , Mor Freed-Freundlich  2 , Avichai Shimoni  2 , Tamer Hellou  2 , Abraham Avigdor  2 , Mudi Misgav  1 , Jonathan Canaani  2
Affiliations

Defining Current Patterns of Blood Product Use during Intensive Induction Chemotherapy in Newly Diagnosed Acute Myeloid Leukemia Patients

Liron Miller et al. Transfus Med Hemother. .

Abstract

Introduction: Blood product transfusion retains a critical role in the supportive care of patients with acute myeloid leukemia (AML). Whereas previous studies have shown increased transfusion dependency to portend inferior outcome, predictive factors of an increased transfusion burden and the prognostic impact of transfusion support have not been assessed recently.

Methods/patients: We performed a retrospective analysis on a recent cohort of patients given intensive induction chemotherapy in 2014-2022.

Results: The analysis comprised 180 patients with a median age of 57 years with 80% designated as de novo AML. Fifty-four patients (31%) were FLT3-ITD mutated, and 73 patients (42%) harbored NPM1. Favorable risk and intermediate risk ELN 2017 patients accounted for 43% and 34% of patients, respectively. The median number of red blood cell (RBC) and platelet units given during induction were 9 and 7 units, respectively. Seventeen patients (9%) received cryoprecipitate, and fresh frozen plasma (FFP) was given to 12 patients (7%). Lower initial hemoglobin and platelet levels were predictive of increased use of RBC (p < 0.0001) and platelet transfusions (p < 0.0001). FFP was significantly associated with induction related mortality (42% vs. 5%; p < 0.0001) and with FLT3-ITD (72% vs. 28%; p = 0.004). Blood group AB experienced improved mean overall survival compared to blood group O patients (4.1 years vs. 2.8 years; p = 0.025). In multivariate analysis, increased number of FFP (hazard ratio [HR], 4.23; 95% confidence interval [CI], 2.1-8.6; p < 0.001) and RBC units (HR, 1.8; 95% CI, 1.2-2.8; p = 0.008) given was associated with inferior survival.

Conclusion: Transfusion needs during induction crucially impact the clinical trajectory of AML patients.

Keywords: ABO blood group; Acute myeloid leukemia; Induction; Transfusion.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1.
Fig. 1.
Impact of blood group on overall survival of AML patients undergoing intensive induction chemotherapy.
Fig. 2.
Fig. 2.
Association of receipt of pre-storage leukodepleted RBC and overall survival in AML patients during induction chemotherapy.
Fig. 3.
Fig. 3.
Assessment of the impact of FFP transfusions on patient survival during induction chemotherapy.
See this image and copyright information in PMC

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