Profile of Chronic Transfusion-Dependent Patients In Spain (20CH Study)

Abstract 4408

Chronic transfusion dependence increases the risk of developing iron overload which potentially could have a negative impact on the patient. It has not yet been studied in depth the profile of chronic transfusion-dependent patients, and their therapeutic management. Our objective was to describe the clinical characteristics of chronic transfusion-dependent patients in Spain. An epidemiologic, cross-sectional and multicenter study was performed in 41 Haematology Services according to clinical practice. Patients ≥18 years old, who started to be chronically transfused after January 2007 and who had received at least 10 red blood cell (RBC) units at the time of inclusion were enrolled in the study. A total of 631 patients were analyzed, 56.2% were men with mean age of 65.0 years (deviation standard=17.0). The principal cause of transfusion dependence was of haematological nature (92.9%), being myelodysplasic syndromes (35.8%) the most frequent cause, followed by acute myeloid leukaemia (28.8%), medullary aplasia (6.3%) and myeloproliferative syndromes (6.0%). 15.5% of patients with non-haematological causes of transfusion dependence was observed, being neoplasia the most frequent cause (6.7%). A median of 22 RBC units were transfused in total to the population in study and a median of 14 RBC units were transfused in the last year. 59.3% of patients received ≥20 RBC units. Regarding iron overload, median serum ferritin (SF) level was 1,173.5 ng/ml and 48.7% of patients had SF ≥1000 ng/ml. SF level was not available in 16.3% of patients. Moreover, 18.7% of patients had their last SF measurement done before the study initiation while 64.8% of the SF measurements were performed during the study. The concomitant diseases reported were mainly cardiovascular (24.4%), urogenital (11.7%) and endocrine (10.1%). A higher number of comorbidities was observed in the group of patients with SF ≥1000ng/ml, specially cardiovascular, hepatic and endocrine disease. Of all patients with chronic transfusion dependence, 14.1% received chelation therapy, being deferasirox the most commonly used drug (89.0%). The reason for not receiving chelation treatment was unknown in 28.2% of patients. 13.2% of patients with iron overload did not receive chelation therapy due to present concomitant diseases: neoplasias (6.7%) and renal and urinary disorders (3.0%). A good correlation between transfused RBC units and SF levels was observed in the study (59.3% received ≥20 RBC units, and 48.7% had SF levels ≥1000ng/ml). It was noted that monitoring of iron overload by SF levels is not followed properly in patients with chronic transfusion dependence. 16.3% of patients did not have any SF measurement and in 18.7% of patients the last SF determination was prior to the study. These data may be related to the fact that 28.2% of patients did not receive chelation therapy due to unknown causes.