Abstract

Objective: Blood transfusions in oncology patients (pts) occur at various hemoglobin (Hb) levels depending on each pt’s characteristics and situation, including underlying malignancy, treatment and comorbidities. Minimal data on the Hb levels at which transfusions are given in these pts are available. To characterize those Hb levels, or transfusion triggers, in oncology pts receiving ESAs, observational data from an ongoing registry were analyzed.

Methods: Real-world data on ESA-treated oncology pts in United States oncology clinics were analyzed from an ongoing prospective, observational registry (Dosing and Outcomes Study of Erythropoiesis-Stimulating Therapies [DOSE}). Data were collected from participating hospital- and community-based outpatient practices between December 2003 and July 2007. Hb values within 3 days prior to transfusion were assessed and summarized. If multiple Hb values were recorded, the Hb value closest to the transfusion was reported. Similarly, if two Hb values occurred on the same day, the lower of the values was reported.

Results: Of 334 transfusions, 314 had a Hb reported within 3 days. While the mean transfusion trigger was 8.55g/dL (SD 1.1), the trigger ranged from <7 to >10g/dL. Sixty-nine percent of transfusions occurred with a Hb trigger of ≥8g/dL, including 9% with a transfusion trigger >10g/dL, as described in the table below. Subgroup analyses based on age (< 65 v ≥65) and payer type (Medicare v other) reported similar findings.

Conclusion: Data from this ongoing observational registry found that the Hb transfusion trigger in oncology pts treated with ESAs varies considerably, with the majority of transfusion events occurring at Hb ≥8.0g/dL and approximately 9% occurring at Hb>10g/dL. Further analyses should explore pt characteristics as well as clinic-specific or other factors that may help to explain this variation.

Transfusion trigger<7g/dL7–7.9g/dL8–8.9g/dL9–9.9g/dL>10g/dL
All patients      
Number of transfusions (%) (N=314) 12 (4%) 89 (28%) 140 (45%) 46 (15%) 27 (9%) 
Subset by age      
Age≥65 (n=155) 7(5%) 45 (29%) 70 (45%) 19 (12%) 14 (9%) 
Age <65 (n=159) 5 (3%) 44 (28%) 70 (44%) 27 (17%) 13 (8%) 
Subset by payer type      
Medicare (n=150) 7 (5%) 45 (30%) 62 (41%) 19 (13%) 17 (11%) 
Other (n=164) 5 (3%) 44 (27%) 78 (48%) 27 (16%) 10 (6%) 
Transfusion trigger<7g/dL7–7.9g/dL8–8.9g/dL9–9.9g/dL>10g/dL
All patients      
Number of transfusions (%) (N=314) 12 (4%) 89 (28%) 140 (45%) 46 (15%) 27 (9%) 
Subset by age      
Age≥65 (n=155) 7(5%) 45 (29%) 70 (45%) 19 (12%) 14 (9%) 
Age <65 (n=159) 5 (3%) 44 (28%) 70 (44%) 27 (17%) 13 (8%) 
Subset by payer type      
Medicare (n=150) 7 (5%) 45 (30%) 62 (41%) 19 (13%) 17 (11%) 
Other (n=164) 5 (3%) 44 (27%) 78 (48%) 27 (16%) 10 (6%) 

Author notes

Disclosure:Employment: Dr. McKenzie, Mr. Bookhart, and Ms. Piech are employees of Ortho Biotech Clinical Affairs, LLC. Consultancy: Drs Larholt, Burton, and Pashos are paid consultants of Ortho Biotech Clinical Affairs, LLC. Ownership Interests:; Dr. McKenzie, Mr. Bookhart, and Ms. Piech own stock in Johnson & Johnson.