Effect of Red-Cell Transfusion Events on Transplant Related Mortality and Overall Survival in Children with Leukemia Undergoing Hematopoietic Stem Cell Transplant Open Access

Abstract

Recent clinical studies in adult oncology patients have shown that an elevated ferritin level prior to hematopoietic stem cell transplant (HSCT), serving as a surrogate marker of body iron load, is independently associated with transplant related mortality (TRM) and inferior overall survival (OS) in adult oncology patients. There is emerging evidence in the pediatric leukemia population that the same may be true. We hypothesized that another marker of body iron load, high red-blood cell (RBC) transfusion events, may be associated with TRM and inferior OS in a heterogeneous group of children with leukemia treated with HSCT.

We performed a retrospective cohort study of 112 children with leukemia treated at our institution over the last 10 years. Approximately 1/3 of the children had high RBC event number, which we defined as greater than 12 RBC transfusion events prior to HSCT, and 2/3 had low RBC event number. Both groups were similar in regards to age, diagnoses, donor type (matched related, matched unrelated, mismatched related, mismatched unrelated), stem cell source (peripheral blood, umbilical cord, bone marrow), baseline liver, cardiac and renal function, and median follow-up time. However, more children in the low RBC transfusion event cohort had high performance scores (83.5% vs 54.5%, p = 0.001) and fewer had recurrent leukemia or other forms of advanced disease compared with the children more heavily transfused (41.8% vs 87.9%, p < 0.0001).

We found no association between number of transfusion events and TRM in our patients in both univariate and multivariate analysis. Patients with a high RBC event number did have an inferior 5-year OS (39%, 95% confidence interval [CI] 22 - 55%) compared with patients with low RBC events (56%, 95% CI 42 - 68%). However, when controlling for patient age, stage of disease, type of transplant, and performance score, number of RBC events lost prognostic significance. Likely more advanced disease and lower performance score in the high RBC event cohort was responsible for the survival difference.

Table of Contents

Table of Contents
1. Introduction...1
2. Background...3
3. Methods...7
4. Results...14
5. Discussion...17
6. References...20
7. Figures/Tables...22

About this Master's Thesis

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School	Laney Graduate School
Department	Clinical Research Curriculum Program
Degree	MS
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Medicine and Surgery
Keyword	leukemia hematopoietic stem cell transplant transfusion
Committee Chair / Thesis Advisor	Mertens, Ann, Emory University
Committee Members	Josephson, Cassandra D, Emory University Boring, John R, Emory University McGowan Jr., John E, Emory University Horan, John T, Emory University Klein, Mitchel, Emory University

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