Autologous blood transfusions lead to worse long term prognosis in colorectal cancer

Key study points:

1. Overall and colorectal cancer specific survival rates are worse in patients receiving autologous versus allogeneic blood transfusions follow surgery for colorectal cancer.

Primer: There exists a known negative effect on survival is patients of solid tumors receiving post-operative blood transfusions especially in colorectal cancer. Allogeneic blood transfusion leads to transfer of a large amount of foreign antigens into the recipient that can have a down-regulatory effect on the immune system. However, perioperative allogeneic blood transfusions still occur from 32-68% of the time in open colorectal cancer. Alternatives to blood transfusions have been attempted, including leukocyte depleted allogeneic transfusions, erythropoietin alfa, and preoperative autologous blood donation programs. Autologous blood donation involves drawing units of blood from the patient preoperatively, and has been the most studied alternative to allogeneic transfusions. The study authors report on the 20 year follow-up results of a randomized controlled trial comparing allogeneic and autologous blood transfusions of 475 colorectal cancer patients operated on between 1986 and 1991. 

Background reading:

1. Vamvakas EC, Blajchman MA. Deleterious clinical effects of transfusion-associated immunomodulation: fact or fiction? Blood. 2001;97:1180–1195.

2. Busch OR, Hop WC, Hoynck van Papendrecht MA, et al. Blood transfusions and prognosis in colorectal cancer. N Engl J Med. 1993;328:1372–1376.

This [randomized, controlled multicenter ] study: 475 patients were randomized to receive either allogeneic or autologous (2 units of their blood 5 days before surgery) blood transfusions following surgery for colorectal cancer from 1986 to 1991. Patients were tracked for follow-up via 5 year questionnaires sent to their physicians, as well as through a national electronic record system to confirm survival and cause of death, if applicable. Overall survival at 20 years was worse in the autologous group (21%) compared with the allogeneic group (28%, p=.041). Multivariate cox regression accounting for tumor stage, age, and sex found a hazard ratio of 1.24 (p= .051) associated with autologous versus allogeneic transfusions. Colorectal cancer specific survival at 10 years was also worse for the autologous group (48% versus 60%, p=.02).

In sum: Contrary to the prevailing belief at the time that blood transfusions could have a deleterious effect on in cancer patients, this study reports long term results that show autologous blood transfusion actually results in decreased survival. These results are especially valuable in that they report 20 year follow-up survival data. Blood donation preoperative in the autologous transfusion group did lead to lower hemoglobin levels and the need for more transfusions post-operatively. To date, there remains no alternative to allogeneic blood transfusion that has shown a clear benefit.

Click to read the study in [Annals in Surgery]

By [AH]

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