Optimal

Background

High amounts of blood products are given to patients with hemato-oncological diseases, either because of induction chemotherapy, hematopoietic stem cell transplantation (SCT) or because of the underlying disease itself. Transfusion policies -especially red blood cell transfusion- are not evidence-based and therefore vary widely among treatment centers. Associated side-effects of red blood cell (RBC) transfusions may have detrimental effects on the outcome of hemato-oncological patients. Furthermore, blood products are costly and should be administered only when necessary.

Rationale

Stimulating the safe and effective use of blood products and performing research that will help to achieve this, is one of the primary objectives of Sanquin. Due to a lack of evidence-based guidelines on transfusion policy in this patient group, we expect large differences between and even within centers without large differences in overall survival. More uniform and restrictive RBC use in hemato-oncological patients, will next to the expected reduction of RBC transfusion side-effects, also significantly reduce costs and labour.

Methodology

The OPTIMAL study is a retrospective, observational study on blood transfusion practice in patients with acute myeloid leukemia in the Netherlands. From AML patients included in the HOVON trials 29, 42, 92 or 102 in the Netherlands, who received at least two intensive chemotherapy courses and reached a first complete remission after one or two courses, transfusion and laboratory data will be collected from the different hospitals. Hemoglobin-based red blood cell transfusion triggers, platelet count-based transfusion triggers as well as the number of red blood cell transfusions per transfusion episode will be compared among the different treatment centers. This study could be the first step in the development of a more uniform guideline in order to improve quality of care for this vulnerable patient group.

Research Staff 

• Marlijn Hoeks^1,2,3
• Rutger Middelburg^1,2,3
• Marian van Kraaij^1,2,4,5
• Jaap Jan Zwaginga^1,2,6

1. Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
2. Jon J van Rood Center for Clinical Transfusion Research, Sanquin-Leiden University Medical Center, Leiden, The Netherlands
3. Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
4. Department of Donor Studies, Sanquin Research, Amsterdam, The Netherlands
5. Unit Transfusion Medicine, Sanquin Blood Bank, Amsterdam, The Netherlands
6. Department of Immuno-hematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands

Collaborators

• Prof. Dr. J. Cornelissen^1,2
• Dr. Van der Holt²
• Prof. Dr. N.M.A. Blijlevens³

1. Department of Hematology, ErasmusMC, Rotterdam, The Netherlands
2. HOVON (Stichting Hemato-oncologie Volwassenen Nederland), ErasmusMC, Rotterdam, The Netherlands
3. Department of Hematology, Radboudumc, Nijmegen, The Netherlands

Reference

1. Tinegate H, Pendry K, Murphy M, et al. Where do all the red blood cells (RBCs) go? Result of a survey of RBC use in England and North Wales in 2014. Transfusion. 2016;56:139-45
2. Bruun MT, Pendry K, Georgsen J, et al. Patient Blood Management in Europe: surveys on top indications for red blood cell use and Patient Blood Management organization and activities in seven European university hospitals. Vox Sanguinis. Doi 10.111/vox. 12435
3. BCSH Guidelines for the clinical use of red cell transfusions. BJH. 2001;113:24-31.
4. CBO-richtlijn Bloedtransfusie 2011
5. Carson JL, Grossman BJ, Kleinman S, et al. Red blood cell transfusion: clinical practice guideline from the AABB. Ann Intern Med. 2012;157:49-58.
6. Cremers E., de Swart L., Huls G., et al. Het myelodysplastisch syndroom: adviezen voor ijzerchelatie bij secundaire hemochromatose. Ned Tijdschr Hematol 2014;11:215-21