Cancer Survival Not Impacted by Red Blood Cells Storage

The duration of storage of transfused red blood cells (RBC) has been associated with poor clinical outcomes and may influence cancer patients overall survival or recurrence.

The goal of RBC transfusion is to increase the delivery of oxygen to tissue in vulnerable patients and remains an essential component in the management of medically ill patients, but changes that occur during storage might impair oxygen delivery through a multitude of metabolic and physiologic changes that ensue.

Transfusion specialists at the Ottawa Hospital (ON, Canada) analyzed the data from 27,591 patients diagnosed with cancer between January 01, 2000 and December 31, 2005. There were 1,929 patients who had received RBC transfusions within one year from diagnosis. Transfused RBC units were categorized as "new'' if stored for less than 14 days, "intermediate'' if stored between 14 and 28 days and "old'' if stored for more than 28 days.

Overall survival was not associated with duration of storage of transfused RBC with a median survival of 1.2 years for new RBC units, 1.7 years for intermediate storage, and 1.1 years for older RBC units. The mean number of RBC transfusions was 3.42 with 55.5% of patients, receiving between one to two RBC units. Of those patients who received a RBC transfusion within one year from diagnosis, 56.8% were transfused within the first six months. Almost half of the patients requiring transfusion within the first year from diagnosis had either a gastrointestinal or lung malignancy.

Cancer recurrence, defined as recurrence of original malignancy or new metastatic disease, was significantly higher in patients who received a RBC transfusion than those who did not, but recurrence rates were not significantly influenced by the duration of storage of transfused RBC. The data from the study suggests that the duration of storage of transfused RBC has a negligible effect on overall survival (OS) of cancer patients. Not surprisingly, OS was influenced by the patient’s age, advanced stage, chemotherapy and radiation use, cancer-related surgery and cancer recurrence. Although receiving a RBC transfusion was associated with OS in univariate analysis, this was not evident when accounting for confounding variables.

The authors concluded their study highlights the inferior survival of cancer patients requiring RBC transfusions; however, there is no apparent influence of the duration of storage of transfused RBC units on OS or cancer recurrence. They concluded that current RBC transfusion policies that do not differentiate between duration of storage of RBC units are adequate for patients with underlying malignancy. The study was published on July 16, 2013, in the journal Public Library of Science ONE.

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