A Restrictive Red Cell Transfusion Approach Does Not Adversely Affect Day 100 or 1 Year Survival in Multiple Myeloma Patients Undergoing Autologous Peripheral Blood Stem Cell Transplantation

Introduction:  The benefits of a restrictive transfusion approach (i.e. improved survival/ decreased infections) have been demonstrated in a variety of hospitalized patient populations. There are little data in the oncology setting outside of the transplantation programs successfully treating Jehovah Witnesses, who generally decline blood product support. The University of Alabama at Birmingham adopted a hospital wide restrictive transfusion policy in February, 2008; specifically in non-bleeding patients, the threshold for transfusion is 7 g/dl and 1 unit of red cells is to be transfused and the patient reassessed prior to considering additional transfusions.  Our stem cell transplant program adopted this policy with the exception that patients with diastolic/systolic dysfunction were maintained at a higher hemoglobin.   

Objective:The purpose of this outcome analysis is to review the impact of a restrictive red cell transfusion approach in multiple myeloma patients undergoing autologous PBSC transplant.  Materials and methods: We collected data for 200 multiple myeloma subjects:  100 patients transplanted in 2005-2007 were compared to 100 patients who underwent transplantation utilizing the restrictive transfusion policy (2009-2011).  Initial analysis included Day 100 and 1- year mortality recognizing that  the latter could be influenced by many other factors, including disease recurrence. Results/Conclusion:

<align="center">	<align="center">Pre-restrictive Approach	<align="center">Restrictive Approach
<align="center">Day 100 Mortality	<align="center">2/100	<align="center">3/100
<align="center">1-year Mortality	<align="center">11/100	<align="center">8/100

Day 100 and 1- year mortality were not adversely affected by the adoption of a restrictive transfusion approach.  A statistical difference was not expected as the mortality associated with auto PBSC for  multiple myeloma is low.  Further analysis of our entire multiple myeloma population will be presented.  Analysis will include the impact of a restrictive transfusion approach on transplant-related co-morbidities, particularly infections.  Additionally, we will compare the number of blood products utilized in these 2 cohorts.