RESUMEN
To examine the relationship of blood product support to treatment outcome in childhood ALL, we reviewed records of all 358 patients with newly diagnosed ALL treated on St Jude Total Therapy Study XI (February 1984 to September 1988). All but six patients received blood products (median 7 units, range 0-246), with approximately 90% given during the 6-week induction period. Because all 16 patients who received > or = 50 units failed, the number of units transfused was predictive of treatment failure in multivariate analysis (relative risk = 1.8, p = 0.02), although the number of units transfused was also associated with initial leukocyte count and age. Among the remaining 342 patients who received < 50 units, the number of units transfused was associated with reduced event-free survival in univariate analysis only, with maximal significance at > 7 units (p = 0.006). Because exclusion of the 16 patients who received the most blood eliminates the independent effect of transfusions on patient outcome, we believe that the number of transfusions is largely an epiphenomenon which reflects the effects of two risk factors not included in traditional outcome analysis in childhood ALL. These are acuity of illness during induction, and reduction of chemotherapy doses during induction therapy, due to the severity of illness. Immunomodulation caused by exposure to blood products appears unlikely to contribute strongly to outcome in childhood ALL.
Asunto(s)
Transfusión Sanguínea , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Niño , Preescolar , Estudios de Cohortes , Transfusión de Eritrocitos , Humanos , Transfusión de Plaquetas , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiología , Pronóstico , Factores de Riesgo , Reacción a la Transfusión , Resultado del TratamientoRESUMEN
The effects of brief warming of stored platelet concentrates were assessed in 15 children undergoing transfusion for stable thrombocytopenia due to chemotherapy (n = 13) or aplastic anaemia. Half of a pool of platelet concentrates stored at 22 degrees C was incubated at 37 degrees C for 1 hour and the other half at room temperature. Each patient received one bag of warmed and one of unwarmed cells transfused in random order 2 h apart. Platelet warming improved transfusion efficacy, as assessed on the basis of corrected platelet count increments (CCIs) and platelet morphology. Compared with unwarmed bags, warmed bags had a higher morphology score (p = 0.0001) and a higher CCI (adjusted for the transfusion order) at 1 h (n = 11; p = 0.014) and at 2 h (n = 15, p = 0.006) post transfusion. Thus, with platelets stored at room temperature bags warmed before transfusion to 37 degrees C for 1 h provide a larger number of circulating platelets after transfusion than do unwarmed bags.