Lower Red Blood Cell Transfusion Research Articles

The efficacy and safety of low-dose chemotherapy combined with tyrosine kinase inhibitors in the treatment of Philadelphia-chromosomal-positive acute lymphoblastic leukemia

目的探讨低剂量化疗联合酪氨酸激酶抑制剂（TKI）作为Ph染色体阳性急性淋巴细胞白血病（Ph+ ALL）诱导治疗方案的有效性与安全性。方法回顾性分析2008年1月1日至2021年7月31日北京大学人民医院收治的217例初诊Ph+ ALL患者的临床资料，通过logistics回归和Cox回归分析，比较低剂量化疗与常规剂量化疗的疗效及不良反应。结果研究纳入217例患者，中位年龄38（10～69）岁，低剂量化疗组78例，常规剂量化疗组139例。低剂量化疗组与常规剂量化疗组相比，4周完全缓解（CR）率（98.7％对97.0％，P＝0.766）及总CR率（100％对100％，P＝1.000）差异均无统计学意义。多因素分析显示，化疗剂量对无病生存率、总生存率无显著影响。而两组诱导化疗期间感染发生率（OR＝0.444，95％ CI 0.227～0.866，P＝0.017）、粒细胞缺乏持续时间（OR＝0.272，95％ CI 0.128～0.576，P＝0.001）、PLT<20×109/L持续时间（OR＝0.487，95％ CI 0.232～1.022，P＝0.057）及红细胞悬液输注量（OR＝0.309，95％ CI 0.147～0.651，P＝0.002）差异有统计学意义，低剂量组均显著低或短于常规剂量化疗组。结论对于Ph+ ALL患者，低剂量化疗联合TKI作为一线诱导治疗的疗效与常规剂量化疗相当，且安全性好。

Volumetric de-escalation and improved acute toxicity with proton craniospinal irradiation using a vertebral body-sparing technique.

In growing children, craniospinal irradiation (CSI) has historically treated the entire vertebral body (VB) to avoid potential long-term spinal abnormalities. Vertebral body-sparing proton craniospinal irradiation (VBSpCSI) is a technique that spares the majority of the VB from significant irradiation, and long-term safety outcomes have been reported previously. This retrospective study reviews the acute toxicity profile of children treated with VBSpCSI in a cohort comparison with photon-based craniospinal radiotherapy (3DCRT). Thirty-eight pediatric CSI patients treated between 2008 and 2018 were retrospectively evaluated for treatment-related toxicity. Acute toxicity outcomes and acute hematologic profiles were compared according to treatment modality, either VBSpCSI or 3DCRT. Statistical analysis was performed using Fisher's exact test for toxicity. Twenty-five patients received VBSpCSI and 13 patients received photon CSI. Mean patient age at treatment was 7.5years (range 2-16). The cohorts were well matched with respect to gender, age, and CSI dose. Patients receiving VBSpCSI had lower rates of grade 2+ gastrointestinal (GI) toxicity (24% vs. 76.5%, p=.005), grade 2+ nausea (24% vs. 61.5%, p=.035), and any-grade esophagitis (0% vs. 38%, p=.0026). Patients treated with VBSpCSI had lower red blood cell transfusion rates (21.7% vs. 60%, p=.049) and grade 4+ lymphopenia (33.3% vs. 77.8%, p=.046). VBSpCSI in children is a volumetric de-escalation from traditional volumes, which irradiate the entire VB to full or intermediate doses. In our study, VBSpCSI was associated with lower rates of acute GI and hematologic toxicities. Long-term growth outcomes and disease control outcomes are needed for this technique.

APPLY: Aprospective observational study of clinical practice patterns of darbepoetin alfa use in patients with chemotherapy-induced anemia in Romania.

SummaryPurposeThe primary objective of this study was to evaluate the compliance of Romanian physicians with the national therapeutic protocol and international guidelines on treatment with erythropoiesis-stimulating agents in anemic cancer patients receiving chemotherapy. The secondary objective was to assess the hemoglobin (Hb) level change due to anemia treatment and safety of darbepoetin alfa.MethodsThis was a single-arm, prospective, longitudinal, multicenter, observational study in patients with nonmyeloid malignancies and symptomatic chemotherapy-induced anemia treated concomitantly with darbepoetin alfa. Patients were followed for the duration of chemotherapy, but no shorter than three and no longer than eight cycles, irrespective of their exposure to darbepoetin alfa.ResultsIn this study, 497 patients with a mean age of 60.6 years were analyzed. Most patients (80.7%) were initiated on darbepoetin alfa at a Hb of 9–11 g/dL, congruent with recommendations. The median Hb increased by 0.9 g/dL between baseline and week 12. Hb target achievement was higher among patients treated according to guidelines than those initiated at Hb < 9 g/dL. A similar trend was observed for red blood cell transfusion requirements. No new safety signals were reported for darbepoetin alfa.ConclusionsThe majority of patients were treated according to national and international recommendations. Guideline adherence was associated with more frequent achievement of Hb targets and lower red blood cell transfusion requirements compared with patients starting anemia treatment with darbepoetin alfa at lower-than-recommended Hb levels.Electronic supplementary materialThe online version of this article (10.1007/s12254-018-0390-4) contains supplementary material, which is available to authorized users.

Clinical impact of regional citrate anticoagulation in continuous renal replacement therapy in critically ill patients.

Regional citrate anticoagulation (RCA) is being used increasingly in continuous renal replacement therapy (CRRT) as a safer alternative to heparin. However, complex metabolic control to avoid side effects have generated discrepancies about its introduction into everyday practice. We aimed to compare both anticoagulation techniques in terms of efficacy, safety and feasibility. Observational retrospective study performed in 3 specialized ICUs in patients receiving CVVHDF with RCA between January 2013 and May 2016. Heparin-treated patients matched by age, sex and disease severity treated in the preceding year were selected as historic controls. Filter lifetime, number of filters used, haemorrhagic complications and metabolic complications were recorded. 54 patients (27 treated with RCA and 27 with heparin) were included in the study. Filter lifetimes in the first 72 hours were 55.1 ± 21.8 hours in the RCA group compared to 38.8 ± 24.8 hours in the heparin group, (p = 0.004). In addition, the number of filters used in the first 72 hours was significantly higher in the heparin group (2.4 ± 1.3 vs. 1.5 ± 0.7; p = 0.004). There was a trend toward a lower incidence of bleeding in the RCA group, with a significantly lower red blood cell transfusion rate (p = 0.027) in the citrate group. No clinically significant metabolic disturbances were observed in the RCA group. Regarding outcomes, there were no significant differences between groups. These results suggest that the implementation of CVVHDF with RCA using concentrated citrate solutions prolongs filter lifetime, achieves a longer effective hemodiafiltration time and is a safe and feasible method.