Red blood cell transfusion practice and cardiac comorbidities in patients with myelodysplastic syndromes

Evidence guiding optimal transfusion practice for patients with myelodysplastic syndromes (MDS) is lacking. Many patients have concurrent cardiac disease. Data on practice are sparse. We aimed to describe the use of red blood cell (RBC) transfusion and the prevalence of cardiac comorbidities in patients with MDS within Australia's largest public hospital network to better understand real-world practices and outcomes.

We conducted a retrospective cohort study of patients aged ≥18 years with MDS, MDS/myeloproliferative overlap neoplasm or chronic myelomonocytic leukemia admitted from 2016 to 2018 to determine RBC transfusion-related endpoints.

One hundred and seventy-nine patients (median age 78 years, 61.5% male) were included, with a median follow-up of 46 weeks. Of these, 102 (57.0%) received RBC transfusion. Transfused patients had lower presenting Hb (87 vs. 105 g/L, p < 0.0001), higher rates of cardiac disease (29.4% vs. 12.9%, p = 0.009) and 5-azacytidine use (31.4% vs. 13.0%, p = 0.004). Sixty-five patients (36.3%) received outpatient RBC transfusions, with a median of 2 units RBC per transfusion and 14 days between transfusions. The median pre-transfusion Hb was 80 g/L (IQR 74-86 g/L). Forty patients (22.4%) had evidence of cardiac disease, with similar pre-transfusion Hb for patients with and without cardiac disease (median Hb 79 g/L vs. 81 g/L, p = 0.1).

Patients with MDS frequently require RBC transfusion, and restrictive transfusion strategies predominate despite many patients having cardiac comorbidities. Further research is needed to address optimal transfusion strategies in such patients and associated cardiac outcomes.