Quality of Life-Guided Transfusion in Refractory MDS or AML

Centre Hospitalier Universitaire de Nice52 enrolled

Overview

Patients with refractory myelodysplastic syndromes (MDS) or acute myeloid leukemia (AML) in exclusive palliative care frequently receive red blood cell transfusions based on hemoglobin thresholds, despite limited evidence of clinical benefit in this setting. This prospective randomized study compares a standard hemoglobin-based transfusion strategy to a quality-of-life-guided strategy using the EQ-5D-5L questionnaire, with the aim of reducing transfusion burden while maintaining patient safety and quality of life.

This is a prospective, single-center, randomized interventional study conducted in patients with transfusion-dependent refractory MDS or AML receiving exclusive palliative care. Palliative Care Patients are randomized to either a standard transfusion strategy based on hemoglobin thresholds or a quality-of-life-guided strategy in which red blood cell transfusions are triggered by a clinically significant deterioration in EQ-5D-5L score. The study aims to evaluate whether a quality-of-life-guided transfusion strategy can safely reduce the number of red blood cell transfusions without negatively impacting patient-reported outcomes.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

NONE

Enrollment

Conditions

MDS AML, Adult

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Adults aged 18 years and older. * Diagnosis of refractory MDS or AML, receiving palliative care only. * Anaemia with haemoglobin ≤ 8 g/dl at inclusion (or ≤ 9 g/dl if associated with cardiovascular disease). * Transfusion dependency, defined as requiring more than 2 GR transfusions every 8 weeks. * No vitamin B9, vitamin B12 or iron deficiency. * Ability to understand and sign the informed consent form. * Ability to comply with the schedule of visits and other protocol requirements. Non inclusion Criteria: * Previous malignant disease other than MDS or AML (except basal cell or squamous cell carcinoma or carcinoma in situ of the cervix or breast). * Active uncontrolled infection (hepatitis B or C, HIV). * Use of G-CSF. * Confirmed neurocognitive disorders (based on prior diagnosis or clinical assessment by the investigator) impairing comprehension, consent or the ability to reliably complete the EQ-5D-5L questionnaire. * Active uncontrolled heart disease. * Active haemolytic anaemia. * Recent major surgery. * Life-threatening complications of MDS/AML. * Presence of another serious or unstable disease which, in the investigators' opinion, would make participation in the study inappropriate or risky for the patient's safety. * Vulnerable individuals. Exclusion Criteria: * Immediate severe complications related to MDS/AML, such as uncontrolled bleeding, pneumonia with hypoxia or shock, or severe disseminated intravascular coagulopathy. * Withdrawal of the patient's voluntary informed consent.

Outcomes

Primary Outcomes

Number of Red Blood Cell Transfusions

Total number of red blood cell units transfused during the 2-month follow-up period.

Time frame: 2 months

Secondary Outcomes

Quality of Life (EQ-5D-5L)

Change in quality-of-life scores

Time frame: from baseline to 1 month and 2 months.

Overall Survival

Survival status

Time frame: from inclusion to 2 months