From the Guidelines
Packed red blood cells (RBCs) should be leukoreduced before transfusion in patients with lymphoma undergoing chemotherapy. Leukoreduction involves filtering out white blood cells from blood products prior to transfusion, which is crucial for immunocompromised patients like those with lymphoma on chemotherapy. This process helps prevent several complications, including febrile non-hemolytic transfusion reactions, which are caused by recipient antibodies reacting against donor white blood cells, as supported by the American Society of Clinical Oncology clinical practice guideline update 1. It also reduces the risk of cytomegalovirus (CMV) transmission, which can cause serious infections in immunocompromised patients. Additionally, leukoreduction decreases the likelihood of HLA alloimmunization, which can lead to platelet refractoriness in patients who may need multiple transfusions during their treatment course. The immunomodulatory effects of transfused white blood cells might also potentially increase the risk of cancer recurrence or progression, making leukoreduction even more important in oncology patients.
Key benefits of leukoreduction include:
- Reduction in transfusion reactions
- Decrease in transmission of cytomegalovirus (CMV) infection
- Decrease in the likelihood of HLA alloimmunization
- Potential reduction in the risk of cancer recurrence or progression due to immunomodulatory effects of transfused white blood cells
Most modern blood banks now provide leukoreduced blood products as standard practice, but it's still important to specifically request leukoreduced products when ordering transfusions for lymphoma patients, as emphasized in the guideline update 1. The evidence quality for this recommendation is high, and the strength of recommendation is strong, indicating that leukoreduction should be a standard practice for patients with lymphoma undergoing chemotherapy 1.
From the Research
Packed RBC Transfusion in Lymphoma Patients
- Packed red blood cells (RBCs) are often transfused to patients with lymphoma undergoing chemotherapy to treat anemia 2.
- The decision to leukoreduce packed RBCs before transfusion is important to consider, as it may reduce the risk of transfusion-related complications.
Leukoreduction and Transfusion-Related Complications
- Leukoreduction, which involves removing white blood cells from blood products, has been shown to reduce the risk of infectious complications in trauma patients 3.
- Additionally, leukoreduction has been associated with a decrease in febrile nonhemolytic transfusion reactions (FNHTRs) 4.
- Graft-versus-host disease (GVHD) is a rare but potentially fatal complication of transfusion, and leukoreduction may help prevent this condition 5.
Considerations for Lymphoma Patients
- Patients with lymphoma undergoing chemotherapy may be at increased risk for transfusion-related complications due to their immunocompromised state.
- Leukoreduction of packed RBCs may be beneficial in reducing the risk of these complications, although the evidence is not specific to lymphoma patients 6, 3, 5, 4.
- Further research is needed to determine the optimal transfusion strategy for patients with lymphoma undergoing chemotherapy.