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Author Notes:

Cynthia R. Giver, Emory Winship Cancer Institute, Hematology and Medical Oncology, 1365B Clifton Road NE, Suite B5106, Atlanta, GA 30322, Tel: 404-778-5806, Fax: 404-778-3110, cgiver@emory.edu.

SH, EKW, and CRG compiled data, analyzed data, and wrote the paper.

SB and MG compiled data. KAE and NS performed statistical calculations.

ZAK, AA, AGA, CDJ, HJK, JLK, AAL, JDR and JCZ provided clinical expertise, critical review, and revised the manuscript.

We thank Ms. Ariana Rivera and Mr. Daniel Chandra for platelet transfusion data entry.

The authors have no competing financial relationships to disclose.


Research Funding:

This study received funding from NIH NHLBI Program Project Grant P01 HL086773


  • Science & Technology
  • Life Sciences & Biomedicine
  • Hematology
  • Immunology
  • Transplantation
  • Allogeneic HSCT
  • Allogeneic BMT
  • Graft-versus-host disease
  • GVHD
  • Blood transfusion
  • RBC transfusion

Peritransplantation Red Blood Cell Transfusion Is Associated with Increased Risk of Graft-versus-Host Disease after Allogeneic Hematopoietic Stem Cell Transplantation

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Journal Title:

Biology of Blood and Marrow Transplantation


Volume 24, Number 5


, Pages 973-982

Type of Work:

Article | Final Publisher PDF


More than 90% of allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients receive red blood cell (RBC) or platelet transfusions in the peritransplantation period. We tested the hypothesis that transfusions are associated with the development of severe (grade III-IV) acute graft-versus-host disease (aGVHD) or mortality after allo-HSCT in a retrospective study of 322 consecutive patients receiving an allogeneic bone marrow or granulocyte colony-stimulating factor-mobilized blood stem cell graft for a hematologic malignancy. Counting transfused RBC and platelet units between day −7 pretransplantation and day +27 post-transplantation, but excluding transfusions administered after a diagnosis of aGVHD, yielded medians of 5 RBC units and 2 platelet units transfused. Sixty-three patients (20%) developed a maximal grade III-IV aGVHD with onset up to day +150 post-transplantation (median aGVHD onset of 28 days). HLA mismatch (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.2 to 4.7; P =.01), and transfusion of more than the median number of RBC units (HR, 2.1; 95% CI, 1.1 to 3.7; P =.02) were independently associated with greater risk of grade III-IV aGVHD in a multivariable analysis model. Disease risk strata (HR, 1.7; 95% CI, 1.2 to 2.4 for high risk versus low risk; P =.005) and transfusion of more than the median number of RBC units (HR, 1.4; 95% CI, 1.0 to 2.0; P =.054) were independently associated with inferior overall survival. These data support our hypothesis that peritransplantation RBC transfusions are associated with the risk of developing severe aGVHD and worse overall survival following allo-HSCT, and suggest that strategies to reduce routine RBC transfusion may favorably reduce the incidence and severity of GVHD.

Copyright information:

© 2018 The American Society for Blood and Marrow Transplantation

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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