Association between red blood cell transfusion dependence and burden in patients with myelodysplastic syndromes: a systematic literature review and meta-analysis

Health Division, São Paulo, Brazil. Department of Haematology, Oncology and Clinical Immunology, University Hospital Düsseldorf, Düsseldorf, Germany. King's College Hospital NHS Foundation Trust and King's College London, London, UK. Health Division, New York, USA. Bristol Myers Squibb, Princeton, New Jersey, USA.

European journal of haematology. 2021
PICO Summary

Population

Patients with myelodysplastic syndromes (MDS), (38 studies).

Intervention

Two systematic literature reviews and meta-analyses were conducted to understand the impact of transfusion status (TS) on overall survival (OS), and to unravel the impact of TS on clinical (other than OS), economic, and humanistic outcomes in patients with MDS.

Comparison

Outcome

The first systematic review (10 studies) showed consistent decrease in (OS) in transfusion dependent (TD) compared with transfusion independent (TI) patients. These findings were confirmed by a meta-analysis (MA) reporting better OS prognosis for TI patients. A second systematic review (28 studies) showed better prognosis for other outcomes, including AML progression and leukaemia-free survival for TI patients. Risk of acute myeloid leukaemia (AML) progression and cumulative non-leukemic death assessed by the MA showed a trend toward worse prognosis and higher risk of AML progression for TD patients. Lower healthcare resource utilization, better quality of life, and reduced non-leukemic death for TI patients were observed. Studies not eligible for MA also showed better clinical, economic and humanistic outcomes for TI patients.
Abstract
Myelodysplastic syndromes (MDS) are a group of malignant hematologic diseases characterized by ineffective hematopoiesis, which may lead to chronic anemia and transfusion dependency, with up to 30% of patients progressing to acute myeloid leukemia (AML). Studies suggest transfusion dependency may impact overall survival (OS); however, there is a lack of evidence concerning the association between transfusion status (TS) and OS in patients with MDS who become transfusion independent (TI) after treatment. In addition, the holistic impact of TS on other clinical, economic, and humanistic outcomes has not been well understood. We conducted a systematic literature review (SLR) to understand this impact. Ten studies were included and showed consistent decrease in OS in transfusion dependent (TD) compared with TI patients. These findings were confirmed by a meta-analysis (MA) reporting better OS prognosis for TI patients. A second SLR was conducted to understand the association between TS and other clinical, economic, and humanistic outcomes. Twenty-eight studies were included and showed better prognosis for other outcomes, including AML progression and leukemia-free survival for TI patients. Risk of AML progression and cumulative non-leukemic death assessed by the MA showed a trend toward worse prognosis and higher risk of AML progression for TD patients. Lower healthcare resource utilization, better quality of life, and reduced non-leukemic death for TI patients were observed. Studies not eligible for MA also showed better clinical, economic and humanistic outcomes for TI patients. These findings contribute to understanding the association between transfusion dependence and OS among other outcomes in patients with MDS.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine