Trends in transfusion burden among long-term survivors of childhood hematological malignancies

Abstract

The risk from cumulative erythrocyte transfusions is poorly understood in oncology populations. This analysis among long-term survivors explored variation in transfusional burden over progressive eras of treatment identifying those at risk for iron overload. Transfusion records of 982 survivors of hematological malignancies treated at St. Jude were reviewed. After exclusions, 881 (90%) were assessed for cumulative volume, weight-adjusted volume and transfusion number. Treatment intensity was assigned using the Intensity of Treatment Rating Scale version 3.0 (ITR-3). Hematopoietic stem cell transplant and acute myeloid leukemia survivors had greater transfusional burden than conventional therapy recipients and acute lymphoblastic leukemia survivors, respectively. Survivors of 5–10 years were more likely than survivors of > 10 years to receive ≥ 10 transfusions (odds ratio = 2.0, 95% confidence interval 1.5–2.8). Those with higher ITR-3 scores and more recent decades of treatment had a higher transfusional burden. Comprehensive transfusion histories are useful in identifying those at highest risk for iron overload.

Keywords::

• Transfusion medicine
• iron overload
• cancer survivors
• pediatric leukemia

Potential conflict of interest:

Disclosure forms provided by the authors are available with the full text of this article at www.informahealthcare.com/lal.

This work was supported by a Cancer Center Support (CORE) grant CA 21765 from the National Cancer Institute, and by the American Lebanese Syrian Associated Charities (ALSAC).