Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
Support Care Cancer. 2024 Nov 4;32(11):766. doi: 10.1007/s00520-024-08888-3.
Red blood cell (RBC) transfusions play an important role in supportive care in children and neonates with cancer. However, in current clinical practice, evidence-based recommendations are lacking on when to administer prophylactic RBC transfusions. To address this gap, a clinical practice guideline (CPG) was developed to systematically review the available evidence and provide recommendations for clinicians.
A systematic literature review in three databases was conducted. The GRADE methodology was used to assess, extract, and summarize the evidence. A multidisciplinary panel of 21 professionals was assembled to ensure comprehensive expertise. If there was insufficient evidence in children with cancer, additional evidence was gathered in general pediatric or adult oncology guidelines, or the panel utilized shared expert opinion to develop a comprehensive CPG. Multiple in-person meetings were conducted to discuss evidence, complete evidence-to-decision frameworks, and formulate recommendations.
Four studies including 203 children with all types of cancer, met the inclusion criteria. The expert panel assessed all evidence and translated it into recommendations. In total, 47 recommendations were formulated regarding RBC transfusions in children and neonates with cancer. For instance, specific thresholds for prophylactic RBC transfusions were recommended for children and neonates with cancer who have sepsis, are on ECMO, or are undergoing radiotherapy.
This clinical practice guideline presents evidence-based recommendations regarding RBC transfusions in children and neonates with cancer. By providing these recommendations, we aim to guide clinicians and contribute to improving outcomes for children and neonates with cancer.
红细胞（RBC）输血在癌症患儿和新生儿的支持性治疗中起着重要作用。然而，在当前的临床实践中，缺乏关于何时应进行预防性 RBC 输血的循证建议。为了解决这一差距，制定了临床实践指南（CPG），以系统地审查现有证据，并为临床医生提供建议。
在三个数据库中进行了系统文献综述。使用 GRADE 方法评估、提取和总结证据。由 21 名专业人员组成的多学科小组确保了全面的专业知识。如果在癌症患儿中证据不足，则在一般儿科或成人肿瘤学指南中收集更多证据，或小组利用共同的专家意见制定全面的 CPG。进行了多次面对面会议，以讨论证据、完成证据决策框架并制定建议。
四项研究共纳入了 203 名患有各种癌症的儿童，符合纳入标准。专家组评估了所有证据并将其转化为建议。总共制定了 47 条关于癌症患儿和新生儿 RBC 输血的建议。例如，对于患有败血症、接受 ECMO 或接受放射治疗的癌症患儿和新生儿，建议制定预防性 RBC 输血的具体阈值。
本临床实践指南提供了关于癌症患儿和新生儿 RBC 输血的循证建议。通过提供这些建议，我们旨在指导临床医生并为改善癌症患儿和新生儿的结局做出贡献。
