The MDS Beacon™

Researchers from Spain have found that transfusion intensity may be more closely associated with poorer prognosis in myelodysplastic syndromes (MDS) patients than the total number of red blood cell transfusions.

“Our results show that 60 percent of the association strength between transfusion burden and acute leukemia-free survival is mediated by transfusion intensity,” wrote Dr. Arturo Pereira from Hospital Clinic in Barcelona in an email to The MDS Beacon. 

Dr. Pereira presented the findings at the 15^th Congress of the European Hematology Association (EHA) in Barcelona, Spain, last month.

Transfusion intensity refers to the number of red blood cell units a patient needs to have transfused over the course of a typical year. The more red blood cell units a patient needs, the greater the transfusion intensity, which is indicative of a more severe bone marrow failure.

Previous studies have indicated that there is an association between the total number of red blood cell transfusions an MDS patient receives and poor prognosis for the patient. However, the exact link has been unclear.

The Spanish researchers tested three theories for why a high number of red blood cell transfusions might be linked to a poorer prognosis.

The first theory was that it is not really the total number of red blood cell transfusions that is linked to prognosis.  Instead, it is the time since a patient’s MDS diagnosis that matters.  However, because patients diagnosed a longer time ago also will typically have had a larger number of transfusions, it will seem like the number of transfusions is linked to prognosis.

The second theory was that the total number of red blood cell transfusions reflected a higher intensity of transfusions, and the higher intensity of transfusions is what is linked to prognosis.

Finally, the researchers considered whether the total amount of red blood cell units transfused, which is dependent on the number of transfusions as well as transfusion intensity, was linked to poor prognosis.

The researchers reviewed the transfusion histories and blood cell counts of 204 transfusion-dependent patients with MDS or chronic myelomonocytic leukemia. The patients were divided into good and poor prognosis groups based on disease status, chromosomal abnormalities, and median survival. Of the 204 patients studied, 134 received 25 or more red blood cell units.

The researchers found that patients in the poor prognosis group who received 25 or more red blood cell units frequently had shorter periods before developing acute leukemia.

Dr. Pereira said, “The cumulative transfusion burden is merely a surrogate of disease severity.”

The researchers also found that the longer the patients survived without progressing to leukemia, the less likely they were to progress.

However, researchers found that the intensity of red blood cell transfusions had the biggest impact on acute leukemia-free survival.

For more information, please see abstract 0321 at the EHA meeting website.