Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Laboratory of Clinical Chemistry and Hematology, Haga Hospital, The Hague, The Netherlands.
Oncologist. 2020 Feb;25(2):e341-e350. doi: 10.1634/theoncologist.2019-0222. Epub 2019 Aug 27.
Limited data exist on transfusion burden and transfusion-related iron overload in adult survivors of solid malignancies.
Hospital-specific cancer registry data of patients with solid tumor receiving systemic anticancer treatment between January 2008 and September 2009 at the Oncology Department of the Leiden University Medical Center (The Netherlands) were retrieved and cross-referenced with red blood cell (RBC) transfusion records. Individual lifetime transfusion burden was captured in April 2015. Multitransfused long-term survivors with serum ferritin >500 μg/L were subsequently screened for hepatic and cardiac iron overload using 1.5 Tesla magnetic resonance imaging.
The study population consisted of 775 adult patients with solid cancer (45.2% male; median age, 58 years; >75% chemotherapy-treated), 423 (54.6%) of whom were transfused with a median of 6.0 RBC units (range 1-67). Transfusion triggers were symptomatic anemia or hemoglobin <8.1-8.9 g/dL prior to each myelosuppressive chemotherapy cycle. We identified 123 (15.9%) patients across all tumor types with a lifetime transfusion burden of ≥10 RBC units. In the absence of a hemovigilance program, none of these multitransfused patients was screened for iron overload despite a median survival of 4.6 years. In 2015 at disclosure of transfusion burden, 26 multitransfused patients were alive. Six (23.1%) had hepatic iron overload: 3.9-11.2 mg Fe/g dry weight. No cardiac iron depositions were found.
Patients with solid malignancies are at risk for multitransfusion and iron overload even when adhering to restrictive RBC transfusion policies. With improved long-term cancer survivorship, increased awareness of iatrogenic side effects of supportive therapy and development of evidence-based guidelines are essential.
In the presence of a restrictive transfusion policy, ∼30% of transfused adult patients with solid cancer are multitransfused and ∼50% become long-term survivors, underscoring the need for evidence-based guidelines for the detection and management of transfusion-related iron overload in this group of patients. In each institution, a hemovigilance program should be implemented that captures the lifetime cumulative transfusion burden in all patients with cancer, irrespective of tumor type. This instrument will allow timely assessment and treatment of iron overload in cancer survivors, thus preventing organ dysfunction and decreased quality of life.
关于实体恶性肿瘤成年幸存者的输血负担和输血相关铁过载，目前仅有有限的数据。
检索莱顿大学医学中心肿瘤学系 2008 年 1 月至 2009 年 9 月期间接受全身抗癌治疗的实体肿瘤患者的特定医院癌症登记数据，并与红细胞（RBC）输血记录进行交叉核对。2015 年 4 月获取个体终身输血负担。随后对血清铁蛋白＞500μg/L 的多位输血长期幸存者使用 1.5 特斯拉磁共振成像筛查肝和心脏铁过载。
该研究人群包括 775 名成年实体癌患者（45.2%为男性；中位年龄 58 岁；＞75%接受化疗治疗），其中 423 名（54.6%）患者接受了中位 6.0 个 RBC 单位（范围 1-67）的输血。输血触发因素是每个骨髓抑制化疗周期前的症状性贫血或血红蛋白＜8.1-8.9g/dL。我们在所有肿瘤类型中发现了 123 名（15.9%）有≥10 个 RBC 单位的终身输血负担的患者。由于缺乏血液监测计划，尽管中位生存时间为 4.6 年，但这些多次输血的患者中没有一人接受过铁过载筛查。2015 年，在披露输血负担时，26 名多次输血的患者仍存活。其中 6 名（23.1%）有肝铁过载：3.9-11.2mg Fe/g 干重。未发现心脏铁沉积。
即使遵循限制性 RBC 输血政策，实体恶性肿瘤患者也有发生多次输血和铁过载的风险。随着癌症长期生存的改善，提高对支持治疗的医源性副作用的认识并制定循证指南至关重要。
在存在限制性输血政策的情况下，约 30%的接受输血的成年实体癌患者是多次输血的，约 50%成为长期幸存者，这突显了需要为该组患者制定检测和管理输血相关铁过载的循证指南。在每个机构中，应实施血液监测计划，以获取所有癌症患者的终身累积输血负担，无论肿瘤类型如何。该工具将允许及时评估和治疗癌症幸存者的铁过载，从而防止器官功能障碍和降低生活质量。
