Studies of the impact of RBC transfusion on QoL and functional outcomes in MDS
| Study . | Patients . | Study design . | Intervention . | Outcomes assessed . | Comments . |
|---|---|---|---|---|---|
| Bruhn et al31 2020 | 204 outpatients >50 y with hematological or cancer-related diagnosis (40 with MDS) | Observational study | Assessed before RBC transfusion and at days 3, 7, and 28 after RBC transfusion | FACIT-Fatigue | Patients with greater fatigue at baseline had early improvement in fatigue after RBC transfusion but no significant change between day 3 and day 28 after RBC transfusion |
| Caocci et al29 2007 | 32 patients with MDS, 20 received RBC transfusion | Observational study | Measured the association between amplitude of Hb fluctuations with QoL over 1 mo | EORTC QLQC30, patient self-report | Lower variation in Hb correlated with better QoL and lower fatigue; transfusion-free patients reported better QoL and less fatigue than transfused patients |
| Chan et al32 2018 | 101 patients receiving RBC transfusion (inpatients and outpatients), 40 with hematological diagnosis | Observational study | Measured QoL before RBC transfusion and day 1 and day 7 after RBC transfusion | Short Form 12 Version 2 | Greater increase in QoL observed in patients with worse baseline QoL scores; transfusion trigger was not associated with change in QoL |
| FACT-Anemia | |||||
| Hsia et al33 2016 | 20 transfusion-dependent adults (11 with MDS) | Randomized trial (n-of-1 design) | Fresh (<7 d of storage) vs standard-issue (up to 42 d of storage) RBC transfusion | FACT-An, 3 questions on a visual analog scale | No difference in QoL between fresh and standard-issue RBC; no clinically significant improvement in QoL after RBC transfusion (whether fresh or standard) |
| Patient self-report | |||||
| Jansen et al34 2020 | 19 patients with transfusion-dependent MDS | Randomized trial | Liberal (Hb transfusion trigger <97 g/L) vs restrictive (<73 g/L) RBC transfusion protocol | EuroQoL5D, Multidimensional Fatigue Inventory | Terminated prematurely because of slow recruitment |
| No significant differences in symptoms, QoL scores, or cardiovascular outcomes | |||||
| Oliva et al7 2005 | 39 patients with MDS | Observational, cross-sectional study | Cross-sectional study of cardiac and QoL assessment according to transfusion dependence | QOL-E, cardiac echocardiography | Worse QoL in transfused patients compared with nontransfused; higher rates of cardiac remodeling in transfusion-dependent group; cardiac remodeling associated with lower mean Hb levels and older age; each unit of Hb increase predicted a 49% reduction in risk of remodeling |
| St Lezin et al30 2019 | 221 outpatients >50 y with hematological or cancer-related diagnosis (40 with MDS) | Observational study | Assessed before RBC transfusion and 1 wk after RBC | FACIT-Fatigue Scale, FACIT-Dyspnea Scale, 6-min walk test (6MWT) | Clinically important improvement in fatigue or 6MWT but not dyspnea 1 wk after RBC in 70%; patients who maintained Hb 80 g/L at 1 wk, who had not received cancer therapy and who did not need hospitalization, showed clinically important increases in mean 6MWT distance |
| Stanworth et al28 2020 | 38 patients with transfusion-dependent MDS | Randomized trial | Liberal (maintain Hb 100-125 g/L) vs restrictive (maintain Hb 85-100 g/L) RBC transfusion protocol | EQ-5D EORTC QLQC30 | Post hoc exploratory analysis suggested improved QoL (global health, physical functioning, fatigue, and dyspnea) |
| Study . | Patients . | Study design . | Intervention . | Outcomes assessed . | Comments . |
|---|---|---|---|---|---|
| Bruhn et al31 2020 | 204 outpatients >50 y with hematological or cancer-related diagnosis (40 with MDS) | Observational study | Assessed before RBC transfusion and at days 3, 7, and 28 after RBC transfusion | FACIT-Fatigue | Patients with greater fatigue at baseline had early improvement in fatigue after RBC transfusion but no significant change between day 3 and day 28 after RBC transfusion |
| Caocci et al29 2007 | 32 patients with MDS, 20 received RBC transfusion | Observational study | Measured the association between amplitude of Hb fluctuations with QoL over 1 mo | EORTC QLQC30, patient self-report | Lower variation in Hb correlated with better QoL and lower fatigue; transfusion-free patients reported better QoL and less fatigue than transfused patients |
| Chan et al32 2018 | 101 patients receiving RBC transfusion (inpatients and outpatients), 40 with hematological diagnosis | Observational study | Measured QoL before RBC transfusion and day 1 and day 7 after RBC transfusion | Short Form 12 Version 2 | Greater increase in QoL observed in patients with worse baseline QoL scores; transfusion trigger was not associated with change in QoL |
| FACT-Anemia | |||||
| Hsia et al33 2016 | 20 transfusion-dependent adults (11 with MDS) | Randomized trial (n-of-1 design) | Fresh (<7 d of storage) vs standard-issue (up to 42 d of storage) RBC transfusion | FACT-An, 3 questions on a visual analog scale | No difference in QoL between fresh and standard-issue RBC; no clinically significant improvement in QoL after RBC transfusion (whether fresh or standard) |
| Patient self-report | |||||
| Jansen et al34 2020 | 19 patients with transfusion-dependent MDS | Randomized trial | Liberal (Hb transfusion trigger <97 g/L) vs restrictive (<73 g/L) RBC transfusion protocol | EuroQoL5D, Multidimensional Fatigue Inventory | Terminated prematurely because of slow recruitment |
| No significant differences in symptoms, QoL scores, or cardiovascular outcomes | |||||
| Oliva et al7 2005 | 39 patients with MDS | Observational, cross-sectional study | Cross-sectional study of cardiac and QoL assessment according to transfusion dependence | QOL-E, cardiac echocardiography | Worse QoL in transfused patients compared with nontransfused; higher rates of cardiac remodeling in transfusion-dependent group; cardiac remodeling associated with lower mean Hb levels and older age; each unit of Hb increase predicted a 49% reduction in risk of remodeling |
| St Lezin et al30 2019 | 221 outpatients >50 y with hematological or cancer-related diagnosis (40 with MDS) | Observational study | Assessed before RBC transfusion and 1 wk after RBC | FACIT-Fatigue Scale, FACIT-Dyspnea Scale, 6-min walk test (6MWT) | Clinically important improvement in fatigue or 6MWT but not dyspnea 1 wk after RBC in 70%; patients who maintained Hb 80 g/L at 1 wk, who had not received cancer therapy and who did not need hospitalization, showed clinically important increases in mean 6MWT distance |
| Stanworth et al28 2020 | 38 patients with transfusion-dependent MDS | Randomized trial | Liberal (maintain Hb 100-125 g/L) vs restrictive (maintain Hb 85-100 g/L) RBC transfusion protocol | EQ-5D EORTC QLQC30 | Post hoc exploratory analysis suggested improved QoL (global health, physical functioning, fatigue, and dyspnea) |