Restrictive versus liberal red blood cell transfusion strategies for people with haematological malignancies treated with intensive chemotherapy or radiotherapy, or both, with or without haematopoietic stem cell support.

摘要: Background Many people diagnosed with haematological malignancies experience anaemia, and red blood cell (RBC) transfusion plays an essential supportive role in their management. Different strategies have been developed for RBC transfusions. A restrictive strategy seeks to maintain a lower haemoglobin level (usually between 70 g/L 90 g/L) trigger when the drops below g/L), whereas liberal aims higher 100 120 g/L, threshold g/L). In undergoing surgery or who admitted intensive care has shown be safe some cases safer than strategy. However, it is not known whether malignancies. Objectives To determine efficacy safety of versus treated chemotherapy radiotherapy, both, without haematopoietic stem transplant (HSCT). Search methods We searched randomised controlled trials (RCTs) non-randomised (NRS) MEDLINE (from 1946), Embase 1974), CINAHL 1982), Cochrane Central Register Controlled Trials (CENTRAL) (the Library 2016, Issue 6), 10 other databases (including four trial registries) 15 June 2016. We also grey literature contacted experts additional trials. There was no restriction on language, date publication status. Selection criteria We included RCTs prospective NRS that evaluated compared children adults malignant disorders HSCT. Data collection analysis We used standard methodological procedures expected by Cochrane. Main results We identified six studies eligible inclusion this review; five one NRS. Three completed (156 participants), (84 two ongoing RCTs. RCT awaiting classification. The were conducted 1997 2015 had mean follow-up from 31 days 2 years. One study receiving HSCT (six three only adults: 218 participants acute leukaemia chemotherapy, 16 malignancy HSCT. varied g/L. 80 g/L. Based GRADE rating methodology overall quality very low across different outcomes. None free bias all 'Risk bias' domains. discontinued early concerns after recruiting children, group veno-occlusive disease (VOD). Evidence RCTs A policy may make little difference to: number died within (two trials, 95 (RR: 0.25, 95% CI 0.02 2.69, low-quality evidence); experienced any bleeding studies, 149 participants; RR:0.93, 0.73 1.18, evidence), clinically significant participants, RR: 1.03, 0.75 1.43, required transfusions (three trials; 155 participants: 0.97, 0.90 1.05, length hospital stay (restrictive median 35.5 (interquartile range (IQR): 31.2 43.8); 36 (IQR: 29.2 44), evidence). We are uncertain strategy: decreases life (one trial, 89 fatigue score: 4.8 (IQR 4 5.2); 4.5 3.6 5) (very reduces risk developing serious infection study, 1.23, 0.74 2.04, evidence). A reduce per participant (MD) -3.58, -5.66 -1.49, evidence). Evidence NRS We death 84 1 death; 3; 8; (adjusted age, sex myeloid type geometric 1.25; 1.07 1.47 - data analysis performed authors) No found looked at: life; bleeding; infection; stay. No adverse reactions; arterial venous thromboembolic events; admission; readmission hospital. Authors' conclusions Findings review based 240 participants. There evidence participant. effect on: mortality at 30 days, bleeding, stay. This mainly having chemotherapy. Although, (530 participants) due January 2018 will provide information malignancies, we able answer review's primary outcome. If assume rate 3% would need 1492 80% chance detecting, as 5% level, increase all-cause 6%. Further children.