The Impact Of Pre-Transplant Anemia On Long-Term Survival Following Allogeneic Bone Marrow Transplantation.

Background: Anemia is a common finding in patients with malignancies and is associated with reduced survival times. The impact of anemia on survival during allogeneic bone marrow transplantation (alloBMT) was not known. Recently, we identified that low pre-transplant hemoglobin (PT-Hb) levels were associated with increased mortality during the first 6 months after BMT. However, the impact of the PT-Hb on long-term survival was not known. Study Design and Methods: Data from 519 consecutive patients receiving transplants between January 1995 and March 2000 were retrospectively reviewed and survival was evaluated with regard to risk factors, including the PT-Hb until June 2002. Survival was calculated using Kaplan-Meier limit methods. Risk factor subgroups were compared with the log rank test. The PT-Hb levels were determined within 2 weeks of conditioning chemoradiotherapy. Results: PT-Hb levels correlated inversely with survival. The percentile 5-year survival of patients with PT-Hb levels of ≤100, 101–110, 111–120, 121–130 and >130 g/L were 35, 29, 46, 62, and 57, respectively, not taking into account any other known transplant-related risk factors. Patients with PT-Hb levels of ≤110 g/L compared to >110 g/L had 5-year survival rates of 33% versus 56% (p < 0.001). The effect of the PT-Hb on survival was sustained in subgroups of patients presenting with low or high-risk disease at the time of BMT. The overall 5-year survival rate was 46%. By univariate analyses, the PT-Hb, the use of unrelated donors, BMT in patients with more advanced disease and major ABO mismatch between donor and recipient were found to be significant risk factors for mortality. In a multivariate model, a low PT-Hb level was found to be an independent risk factor (p < 0.001; hazard ratio, 1.19 per 10 g/L decrease; 95% CI, 1.10–1.28). Conclusion: Pre-transplant anemia is an independent risk factor for increased long-term mortality during alloBMT. It remains to be determined whether decreased survival is the result of direct effects from anemia or, alternatively, a low PT-Hb level may represent surrogate marker for other adverse transplant-related parameters.