Large, randomized trials have shown that restrictive versus liberal transfusions are safe for a variety of patient groups. However, little data are available for hematology-oncology patients. New data recently presented at the 57th American Society of Hematology Annual Meeting and Exposition suggest that lower hemoglobin thresholds may also be safe for these patients.
In a feasibility pilot trial, adult patients with acute leukemia were randomized with a 2:1 ratio for a low (7 g/dL) and high (8 g/dL) transfusion threshold, and patients were monitored for 60 days. To date, 59 patients in the low threshold arm and 30 patients in the high threshold arm have been evaluated. Although patients in the high threshold arm received a greater median number or red cell transfusions (p=0.01), the length of hospital stay, fatigue scores, and bleeding events were similar in both groups. This study supports the feasibility of conducting a larger trial to confirm the safety of restrictive transfusion in acute leukemia, and perhaps, other oncologic patients.