Exploring the rationale for red cell transfusion in myelodysplastic syndrome patients: emerging data and future insights. Issue 5 (4th May 2022)

• Record Type: Journal Article
• Authors: Finelli, Carlo; Parisi, Sarah; Paolini, Stefania
• Is Part Of: Expert review of hematology. Volume 15:Issue 5(2022)
• Page Start: 411
• Page End: 421
• Publication Date: 2022-05-04
• Subjects: Myelodysplastic syndromes -- anemia -- red cell transfusion -- iron overload -- iron chelation -- health-related quality of life; Hematology -- Periodicals; 616.15005
• DOI: 10.1080/17474086.2022.2077721
• Languages: English
• ISSNs: 1747-4086

Abstract

ABSTRACT: Introduction: Anemia is often present in mostly elderly patients with myelodysplastic syndromes (MDS), and is associated with a poorer outcome. Although red blood cell (RBC) transfusions are the most immediate treatment, waiting for the response to disease-specific therapy, or in case of non-response, the choice of the optimal transfusion regimen is still controversial. Areas covered: The main objectives of RBC transfusion are the control of anemia-related symptoms and complications and the improvement of functional status and of health-related quality of life (HRQoL). However, RBC transfusions are associated with several negative clinical consequences, mainly adverse transfusion reactions and iron overload, which can be counteracted by iron chelation therapy. Recent few pilot prospective trials have shown a benefit, in terms of HRQoL, of more liberal transfusion regimens, with higher hemoglobin (Hb) targets, compared to conventional restrictive regimens, but these results need confirmation by larger studies. Expert opinion: A patient-oriented RBC transfusion therapy in MDS patients must take into account several laboratory (Hb), clinical (age, comorbidities), psychological, family and social factors, and evaluation of HRQoL should become a fundamental parameter in assessing the clinical benefit of therapy. Many questions remain to be clarified, including why some patients report little benefit from transfusions.