A randomized control trial to compare mortality in recipients of leucoreduced and non-leucoreduced whole blood transfusion in patients with cancer in Uganda

• Published in: BMC cancer 2024-06, Vol.24 (1), p.677-9, Article 677
• Main Authors: Okello, Clement D, Orem, Jackson, Nabwana, Martin, Kiwanuka, Noah, Shih, Andrew W, Heddle, Nancy, Mayanja-Kizza, Harriet
• Format: Article
• Language: English
• Subjects: Adult; Aged; Blood products; Blood transfusion; Blood Transfusion - methods; Blood Transfusion - statistics & numerical data; Blood transfusions; Cancer; Cancer patients; Care and treatment; Data collection; Female; Forecasts and trends; Humans; Laboratories; Leucoreduced whole blood; Leukocyte Reduction Procedures - methods; Leukocytes; Male; Middle Aged; Mortality; Neoplasms - mortality; Neoplasms - therapy; Nurses; Patient outcomes; Patients; Prevention; Proportional Hazards Models; Standard of care; Uganda; Uganda - epidemiology
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-024-12445-w

Mortality benefit of transfusion with leucoreduced whole blood has not been demonstrated in the sub-Saharan Africa (SSA). We compared mortality in patients with cancer transfused with leucoreduced and non-leucoreduced whole blood in a SSA setting. An open-label randomized controlled trial was conducted at the Uganda Cancer Institute where participants were randomized in a 1:1 ratio into the leucoreduced and non-leucoreduced whole blood transfusion arms. Leucocyte filtration of whole blood was performed within 72 h of blood collection. Patients aged ≥ 15 years who were prescribed blood transfusion by the primary physicians were eligible for study enrolment. Mortality difference was analyzed using intention-to-treat survival analysis and cox proportional hazard model was used to analyze factors associated with mortality. There were 137 participants randomized to the leucoreduced and 140 to the non-leucoreduced arms. Baseline characteristics were similar between the two arms. The median number of blood transfusions received was 1 (IQR, 1-3) unit and 2 (IQR, 1-3) units in the leucoreduced and non-leucoreduced arms respectively, p = 0.07. The 30-day mortality rate in the leucoreduced arm was 4.6% (95% CI, 2.1-10) and was 6.2% (95% CI, 3.2-12.1) in the non-leucoreduced arm (p = 0.57), representing an absolute effect size of only 1.6%. Increasing age (HR = 0.92, 95% CI, 0.86-0.98, p = 0.02) and Eastern Co-operative Oncology Group (ECOG) performance score of 1 (HR = 0.03, 95% CI, 0.00-0.31, p