Tzounakas Vassilis L, Seghatchian Jerard, Grouzi Elissavet, Kokoris Styliani, Antonelou Marianna H
Department of Biology, School of Science, National and Kapodistrian University of Athens (NKUA), Athens, Greece.
International Consultancy in Blood Component Quality/Safety Improvement, Audit/Inspection and DDR Strategy, London, UK.
Transfus Apher Sci. 2017 Jun;56(3):291-304. doi: 10.1016/j.transci.2017.05.015. Epub 2017 May 26.
Anemia is present in more than half of cancer patients and appears to be an independent prognostic factor of short- and long-term adverse outcomes. It increases in the advanced period of cancer and perioperatively, in patients with solid tumors who undergo surgery. As a result, allogeneic red blood cell (RBC) transfusion is an indispensable treatment in cancer. However, its safety remains controversial, based on several laboratory and clinical data reporting a linkage with increased risk for cancer recurrence, infection and cancer-related mortality. Immunological, inflammatory and thrombotic reactions mediated by the residual leukocytes and platelets, the stored RBCs per se, the biological response modifiers and the plasticizer of the unit may underlie infection and tumor-promoting effects. Although the causality between transfusion and infection has been established, the effects of transfusion on cancer recurrence remain confusing; this is mainly due to the extreme biological heterogeneity that characterizes RBC donations and cancer context. In fact, the functional interplay between donation-associated factors and recipient characteristics, including tumor biology per se, inflammation, infection, coagulation and immune activation state and competence may synergistically and individually define the clinical impact of each transfusion in any given cancer patient. Our understanding of how the potential risk is mediated is important to make RBC transfusion safer and to pave the way for novel, promising and highly personalized strategies for the treatment of anemia in surgical cancer patients.
超过半数的癌症患者存在贫血，且贫血似乎是短期和长期不良结局的独立预后因素。在癌症晚期以及接受手术的实体瘤患者围手术期，贫血发生率会升高。因此，异体红细胞（RBC）输血是癌症治疗中不可或缺的一项治疗手段。然而，基于一些实验室和临床数据报道其与癌症复发、感染及癌症相关死亡率增加存在关联，其安全性仍存在争议。由残余白细胞和血小板、储存的红细胞本身、生物反应调节剂以及血袋增塑剂介导的免疫、炎症和血栓形成反应，可能是感染和肿瘤促进作用的基础。尽管输血与感染之间的因果关系已得到证实，但输血对癌症复发的影响仍不明确；这主要是由于红细胞捐献和癌症背景具有极大的生物学异质性。事实上，捐献相关因素与受者特征（包括肿瘤生物学本身、炎症、感染、凝血以及免疫激活状态和能力）之间的功能相互作用，可能协同且单独地决定每次输血对任何特定癌症患者的临床影响。了解潜在风险的介导方式对于提高红细胞输血的安全性以及为外科癌症患者贫血治疗的新型、有前景且高度个性化策略铺平道路至关重要。
