Today we will be discussing whether blood transfusions predispose patients to prostate cancer reoccurrence after radical prostatectomy.
Although blood transfusions are one of the most common hospital procedures in the United States, they carry risks including potential immunomodulatory effects.
Dr. Sprung explains:
“It has been documented that the use of allogeneic blood transfusion can induce immunosuppression time of surgery is time when there is increased potential for dissemination of tumor cells due to surgical manipulations and if your immune system is suppressed, there is certainly a potential that will result in faster tumor progression.”
Two recent studies published in TRANSFUSION examined whether transfusions are associated with prostate cancer reoccurrence and morbidity.
Dr. Han from Johns Hopkins and his team reviewed more than 7,000 radical prostatectomy patient records between 1994 and 2012 and divided them into three groups: patients without transfusions, autologous transfusions only, and any allogeneic transfusions. Results were adjusted for clinical variables, and patients were followed for a median time of 6 years.
Here is Dr. Han:
“We found that the blood transfusion, whether it is autologous or allogeneic transfusion, does not independently affect the risk of recurrence or survival after radical prostatectomy. Also, the amount of blood transfused did not change the outcome.”
Dr. Sprung and his team at the Mayo Clinic also examined radical prostatectomy patient records from 1991 to 2005. They found almost 400 patients who received allogeneic blood and matched them with two controls who did not receive transfusions. Patients were matched by date of surgery, age, PSA levels, said pathologic tumor stage, Gleason scores, and type of anesthetic. After a follow-up period of about 10 years, allogeneic blood transfusions were not associated with cancer reoccurrence or morbidity.
Dr. Sprung emphasizes that transfusions should be used for prostate cancer patients if they are needed:
“There is no fear of potentiation of tumor growth by administering these cells. So the finding ultimately suggests that the fear of blood transfusion worsening oncological outcomes in patients undergoing prostatectomy for cancer is really not substantiated.”
We’ll be back with another edition of Transfusion News on September 30. Thanks for joining us.
References
1. Chalfin HJ, Frank SM, Feng Z, Trock BJ, Drake CG, Partin AW, Humphreys E, Ness PM, Jeong BC, Lee SB, Han M. Allogeneic versus autologous blood transfusion and survival after radical prostatectomy. Transfusion 2014;54:2168-2174.
2. Vamvakas EC. Allogeneic blood transfusions and cancer recurrence: 20 years later. Transfusion 2014;54:2149-2153.
3. Yeoh TY, Scavonetto F, Weingarten TN, Karnes RJ, van Buskirk CM, Hanson AC, Schroeder DR, Sprung J. Perioperative allogeneic nonleukoreduced blood transfusion and prostate cancer outcomes after radical prostatectomy. Transfusion 2014;54:2175-2181.
Transfusion offers CME credit for this study! Log on at www.wileyhealthlearning.com/trf.
Just to be clear, the original publication from our center on this subject in 1987 included many patients who received allogeneic whole blood and relatively, compared with today, plasma rich red cells. Our findings were that red cells transfused in colorectal, prostate and cervical cancer surgery were not associated with recurrence, but whole blood was associated with recurrence. There are data demonstrating that stored plasma mediates this effect, not leukocytes or red cells. Removal of stored plasma from transfused platelets and red cells in patients with acute leukemia reduces recurrence in early studies. It is also important to remember that allogeneic transfusion of any sort increases the risk of nosocomial infection substantially, and this is dose related. Since infection is the single most common cause of morbidity and mortality in hospitalized patients, restrictive transfusion practices, using leukoreduced transfusions are almost certainly superior and potentially life saving in all surgical patients. Finally, these studies, unlike studies demonstrating the benefits of leukoreduction and plasma removal, are observational, not randomized trials. Randomized trials of autologous transfusions suggest reduced morbidity and cancer recurrence compared with allogeneic transfusions.
One correction–the original study involving whole blood transfusion and prostate cancer recurrence/death was actually in 1988 (Am J Surg. 1988 Nov;156(5):374-80).
Additional evidence linking whole blood transfusions to cancer recurrence were published in:
Transfusion 30: 291 (1990)
Annals of Surgery 207: 410 (1988)
Br Med J (Clin Res Ed). 1986 Aug 30;293(6546):530-3.
Randomized trials demonstrating a potential benefit from autologous transfusion in colorectal cancer surgery:
J Clin Oncol. 1994 Sep;12(9):1859-67.
Lancet. 1993 Nov 27;342(8883):1328-33.
Randomized trial and implementation data supporting improved survival in acute leukemia with saline washing of red cell and platelet transfusions:
BMC Blood Disord. 2004 Dec 10;4(1):6.
Transfusion-Vol. 54 Supplement: 185a (2014) (abstract)