Elsevier

Leukemia Research

Volume 23, Issue 10, October 1999, Pages 953-959
Leukemia Research

Long-term blood product transfusion support for patients with myelodysplastic syndromes (MDS): cost analysis and complications

https://doi.org/10.1016/S0145-2126(99)00113-7Get rights and content

Abstract

Patients with myelodysplastic syndromes (MDS) frequently become dependent on blood transfusions. We analyzed the total transfusion support required, and its complications and cost, following the diagnosis of MDS (total period=79.7 patient-years) in 50 patients followed at the Minneapolis VA Medical Center. From diagnosis of MDS to transformation to AML or death (the MDS phase), 41 patients (82%) required transfusions. The median numbers of transfused blood products per patient per year of follow-up in the MDS phase were: packed red blood cells (pRBC), 11.1 (range, 0–91.3) units, random donor platelets (RDP), 6.8 (range, 0–581) units, and single donor apheresis platelet packs (SDP): 0 (range, 0–40) collections. In the AML phase (time from diagnosis of secondary AML to death or last follow-up), median transfusion requirements per patient (n=5) were 24 (range, 8–88) units pRBC, 94 (range, 24–480) units RDP and 3 (range, 0–19) collections of SDP. Overall, 80% of patients required either special processing or selection of blood products, had reactions to blood products or required premedications (specified/complicated transfusions); 94% of all pRBC and 97% of all platelet transfusions were specified/complicated. The median cost of transfusions per patient was $4048 (range, $0–73 210) during the MDS phase and $13 210 (range, $5288–59 010) during the AML phase. During the MDS phase, the median cost was $4877 (range, $0–67 050) per patient-year of follow-up; the major proportion of this cost was for pRBC transfusions. Long-term support with frequent transfusions for MDS usually requires specially selected or processed blood products, and is associated with a high incidence of transfusion reactions. This study provides baseline data on the costs of transfusion support for MDS, and can be used for comparing resource utilization and costs of long-term transfusion support (supportive care) with growth factor therapy or disease-modifying modalities such as allogeneic transplantation.

Introduction

Myelodysplastic syndromes (MDS) are one of the most frequently occurring bone marrow neoplastic disorders in adults, with an annual incidence of 10 000–20 000 new cases in the US [1]. With the increasing proportion of elderly individuals in the population, the prevalence of MDS will likely rise further in the future [2].

These chronic disorders are characterized by persistent cytopenias and an increased risk of transformation to acute myeloid leukemia (AML) [3]. Allogeneic bone marrow transplantation is the only known curative therapy for MDS [4], but is not feasible for the majority of patients diagnosed with MDS who are elderly and frequently afflicted with other medical conditions. In these patients, death occurs more often from the complications of chronic cytopenias than from transformation to AML [5], [6], [7]. The presence of cytopenias also contributes significantly to an impaired quality of life [8]. The mainstay of therapy often remains supportive, and many patients become dependent on long-term blood transfusions. As compared to younger patients, transfusion requirements may be greater in these elderly patients who have co-existing cardiorespiratory diseases or vascular insufficiency, in order to maintain an adequate hematocrit for tissue oxygenation. Despite the common use of long-term transfusion support for patients with MDS, its costs and complications have not been determined.

Long-term growth factor therapy with erythropoietin (EPO) alone or with granulocyte colony-stimulating factor (G-CSF) has recently been shown to improve anemia and reduce transfusion requirements in patients with MDS [9], [10], [11], [12], [13]. However, this therapy is expensive, and benefits only a proportion of patients with MDS. Novel treatment approaches may ameliorate cytopenias in some patients [14]. Intensive chemotherapy or allogeneic transplantation incurs high short-term costs and morbidity, but has the potential for reducing transfusion support in patients who achieve long-term freedom from disease [4], [15], [16], [17], [18], [19].

Treatment decision analyses for MDS must include a comparison of the costs and potential complications of supportive care (transfusion support) with therapeutic options such as growth factor therapy or transplantation. To assess the costs and complications of long-term transfusion support for MDS, we analyzed the blood product transfusion data on 50 MDS patients diagnosed, followed and transfused at the Minneapolis VA Medical Center (MVAMC).

Section snippets

Patients

Fifty consecutive patients diagnosed with MDS at the MVAMC from 1992 to 1997 were identified retrospectively. Medical records and blood bank records were reviewed for clinical information including demographic data, therapy, transfusions requirements, complications of transfusions, and outcome of patients. The demographic characteristics of the patients and clinical features at presentation are summarized in Table 1. All patients were males, reflecting the patient population at the MVAMC. The

Transfusion requirements

Forty-one of 50 patients (82%) required blood product transfusions in the MDS phase of their disease, whereas 5/5 patients (100%) required transfusions after transformation to AML. In these 50 patients, the median number of units transfused per patient during the MDS phase was eight units pRBC (range, 0–186 units), eight units RDP (range, 0–344 units) and zero collections SDP (range, 0–47 collections). In the AML phase (n=5), median transfusion requirements per patient were 24 units (range,

Discussion

Long-term transfusion support for patients with MDS is costly, frequently requires specially processed blood products, and is complicated by a high incidence of reactions to the transfused blood products. This study provides data on transfusion support in a cohort of elderly patients with MDS who primarily received supportive care. Consistent with the marked range in the degree of anemia and thrombocytopenia that occurs in MDS, the transfusion requirements of individual patients in this study

Acknowledgements

Research grant supported by the United States Department of Veterans Affairs. P Gupta provided the concept, design, contribution to the analysis and interpretation of the data, helped to draft the paper, gave critical revision and final approval to the article and provided administrative and final support. S. LeRoy contributed to the analysis and data interpretation with statistical expertise, assisted with the assembly of the data and provided logistical support. S. Luikart provided technical

References (31)

  • F.R. Appelbaum et al.

    Bone marrow transplantation for myelodysplasia in adults and children: when and who?

    Leukemia. Res.

    (1998)
  • D.J. Weisdorf et al.

    Chronic myelodysplastic syndromes: short survival with or without evolution to acute leukaemia

    Br. J. Haematol.

    (1983)
  • G.J. Mufti et al.

    Myelodysplastic syndromes: a scoring system with prognostic significance

    Br. J. Haematol.

    (1985)
  • M.L. Thomas

    Quality of life and psychosocial adjustment in patients with myelodysplastic syndromes

    Leuk. Res.

    (1998)
  • E. Hellstrom-Lindberg

    Efficacy of erythropoietin in the myelodysplastic syndromes: a meta-analysis of 205 patients from 17 studies

    Br. J. Haematol.

    (1995)
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