Blood Transfusions Associated With Lower-Risk Myelodysplastic Syndromes (LR-MDS): Insights From Hematologists in China
Author(s)
Zhijian Xiao, Doctor1, Hongyan Tong, Doctor2, Yu Wu, Doctor3, Min Zhang, Doctor4, Yanjuan Lin, Doctor5, Yanan You, Master6, Jingrong Zhu, Bachelor6, Ziyan Xue, Bachelor6, Xinran Han, Bachelor6, Yu Jia, Master7, Xingzhi Wang, Doctor7, Xin Wang, Master8, Xiaoyu Xi, Doctor6.
1Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences, Tianjin, China, 2The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China, 3West China Hospital of Sichuan University, Chengdu, China, 4Introduction of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, 5Fujian Medical University Union Hospital, Nanjing, China, 6China Pharmaceutical University, Nanjing, China, 7Bristol-Myers Squibb (China)Investment Co.,Ltd, Shanghai, China, 8Hangzhou Medical College, Hangzhou, China.
1Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences, Tianjin, China, 2The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China, 3West China Hospital of Sichuan University, Chengdu, China, 4Introduction of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, 5Fujian Medical University Union Hospital, Nanjing, China, 6China Pharmaceutical University, Nanjing, China, 7Bristol-Myers Squibb (China)Investment Co.,Ltd, Shanghai, China, 8Hangzhou Medical College, Hangzhou, China.
OBJECTIVES: Lower-risk myelodysplastic syndrome (LR-MDS) patients in China face transfusion dependence (TD) due to limited therapeutic efficacy of existing treatments, increasing risks of acute myeloid leukemia transformation and mortality [1-5]. With no nationwide data on transfusion management in China, this study aimed to characterize clinical practices patterns and identify systemic challenges through expert interviews.
METHODS: Given the non-regional clustering distribution of MDS patients and the complexity of diagnosis, a qualitative study was conducted via purposive sampling of hematologists from regionally representative tertiary hospitals. Inclusion criteria included: 1) Deputy chief or chief physicians in the hematology department; 2) ≥5 years of specialized clinical practice in MDS; and 3) Annual MDS case volume ≥10. Semi-structured online interviews focused on transfusion thresholds, transfusion access and management barriers. Data were analyzed using medians and interquartile ranges (IQRs) for continuous variables.
RESULTS: Nineteen chief physicians from tertiary hospitals (Eastern:4, Western:3, Southern:4, Northern:5, Central:3) participated, with 10-35 years of MDS management experience and average annual case volumes >200. Median LR-MDS diagnosis hemoglobin (Hb) was 65.0 g/L (IQR=60.0-75.0), classified as moderate anemia in China but severe under WHO guidelines [6,7]. Transfusion thresholds aligned at Hb <60.0 g/L. However, systemic delays (73.7% prevalence; median delay:7.0 days, IQR=3.0-40.0) due to blood shortages reduced pre-transfusion Hb to 50.0 g/L (IQR=50.0-60.0). Fragmented transfusion management defined as inconsistent access to designated transfusion facilities affected 57.9% of cases. Among anemic patients, 62.5% (IQR=47.2%-70.8%) developed TD, requiring a median of 6.0 (IQR=6.0-8.0) transfusions during 16-week assessment period, with 2.0 (IQR=2.0-2.0) units administered per session. Therapeutic strategies to mitigate transfusion burden included erythropoiesis-stimulating agents, luspatercept, and hypomethylating agents.
CONCLUSIONS: LR-MDS transfusion management in China faces systemic delays, fragmented access, and high TD rates, driven by regional blood supply constraints. Standardized protocols and multimodal therapies are urgently needed to reduce transfusion burden and improve outcomes.
METHODS: Given the non-regional clustering distribution of MDS patients and the complexity of diagnosis, a qualitative study was conducted via purposive sampling of hematologists from regionally representative tertiary hospitals. Inclusion criteria included: 1) Deputy chief or chief physicians in the hematology department; 2) ≥5 years of specialized clinical practice in MDS; and 3) Annual MDS case volume ≥10. Semi-structured online interviews focused on transfusion thresholds, transfusion access and management barriers. Data were analyzed using medians and interquartile ranges (IQRs) for continuous variables.
RESULTS: Nineteen chief physicians from tertiary hospitals (Eastern:4, Western:3, Southern:4, Northern:5, Central:3) participated, with 10-35 years of MDS management experience and average annual case volumes >200. Median LR-MDS diagnosis hemoglobin (Hb) was 65.0 g/L (IQR=60.0-75.0), classified as moderate anemia in China but severe under WHO guidelines [6,7]. Transfusion thresholds aligned at Hb <60.0 g/L. However, systemic delays (73.7% prevalence; median delay:7.0 days, IQR=3.0-40.0) due to blood shortages reduced pre-transfusion Hb to 50.0 g/L (IQR=50.0-60.0). Fragmented transfusion management defined as inconsistent access to designated transfusion facilities affected 57.9% of cases. Among anemic patients, 62.5% (IQR=47.2%-70.8%) developed TD, requiring a median of 6.0 (IQR=6.0-8.0) transfusions during 16-week assessment period, with 2.0 (IQR=2.0-2.0) units administered per session. Therapeutic strategies to mitigate transfusion burden included erythropoiesis-stimulating agents, luspatercept, and hypomethylating agents.
CONCLUSIONS: LR-MDS transfusion management in China faces systemic delays, fragmented access, and high TD rates, driven by regional blood supply constraints. Standardized protocols and multimodal therapies are urgently needed to reduce transfusion burden and improve outcomes.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE76
Topic
Economic Evaluation, Epidemiology & Public Health
Topic Subcategory
Value of Information
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology