Introduction
Autologous Stem Cell Transplantation (ASCT) offers high curative rates for patients with Multiple Myeloma (MM), Hodgkin’s Lymphoma (HL), and non-Hodgkin’s Lymphoma (NHL). Optimization of blood counts prior to ASCT with cell adjuncts such as erythropoietin (EPO), intravenous iron, aminocaproic acid, and granulocyte colony-stimulating factor (G-CSF) is important to avoid prolonged pancytopenia following conditioning chemotherapy. While there exist no clear guidelines as to a specific hemoglobin level to maintain prior to transplantation, practices often vary with a pre-transplant hemoglobin of 11-12g/dL being recommended from prior literature.
Methods and Results
We conducted a retrospective review of 59 bloodless medicine patients with HL, NHL, and MM at Pennsylvania Hospital’s Centre for Transfusion-Free Medicine (CTFM) undergoing autologous stem cell transplantation. The average hemoglobin on admission for all patients was 12.3g/dL, and this decreased an average of 4.2g/dL from admission to nadir. The average length of stay for all patients was 19.2 days. We found that 5% of patients had hemoglobin values between 9-10g/dL, 10% between 10-11g/dL, 27% between 11-12g/dL, and 57% above 12g/dL. Among these patients, 30-day mortality rates within all sub-groups were 0%, as determined by living status at 30-days post-reinfusion, except for a 6.25% mortality rate (1/16) within the 11-12g/dL group, with no statistical difference in length of stay (ANOVA p=0.8), nor 30-day post-reinfusion mortality rates (ANOVA p=0.7).
Conclusion
Our single-center data analysis suggests that bloodless medicine patients may, in-fact, have a higher tolerance of anemia ahead of conditioning chemotherapy for ASCT compared to previous evidence. Given a lack of significant difference in mortality rates between patients with admission hemoglobin levels as low as 9.7g/dL and higher levels, we believe ASCT can be safely performed in select patients with hemoglobin values below 11g/dL with close inpatient CBC monitoring and treatment with cell adjuncts.