Fewer Blood Transfusions for Patients With AML Has Humanistic, Economic Benefits

As acute myeloid leukemia (AML) progresses and blood counts are adversely affected by cytotoxic chemotherapies, patients frequently receive blood transfusions. Two posters presented at the Academy of Managed Care Pharmacy Nexus 2021 meeting analyzed patient and physician perspectives on blood transfusions in AML.

The first poster, which received the bronze poster award, utilized online surveys as part of a preferences study to understand the impact of attributes, such as transfusion independence, on treatment preferences for both patients and physicians.¹

A total of 77 patients who were newly diagnosed with AML but ineligible for high-intensity chemotherapy (HIC) were included, along with 145 physicians. The researchers examined patient and physician perspectives on the impact of transfusions on treatment attributes, as well as patient perspectives on quality of life (QOL) and out-of-pocket costs (US only).

Patients were more likely to rate achieving transfusion independence as very important (62.3%) compared with physicians (46.9%). Three-fourths (75.3%) of patients reported ≥ 1 transfusion in the past 3 months, and among them, 62.8% said the transfusions at least somewhat affected their QOL. Most patients (62%) reported receiving less than 4 transfusions a month. Activity was impaired due to transfusion one-third of the time (34.7%).

Among the 47 US patients, 35 had reported ≥ 1 transfusion in the past 3 months and 28 (80%) noted that their monthly out-of-pocket infusion costs were more than $500 with 13 (37.1%) reported costs topping $2000.

“Treatments that increase transfusion independence have both humanistic and economic benefits to patients with AML who are ineligible for HIC,” the authors concluded.

In the second poster, the same researchers evaluated the same issues in the context of maintenance therapy for AML after hematopoietic stem cell transplantation (HSCT).² A total of 78 patients (US, n = 46; UK, n = 30; Canada, n = 2) and 145 physicians (US, n = 48; UK, n = 52; Canada, n = 29; Australia, n = 16) were included. Among the patients, the mean AML duration was 34 months and 32.1% of patients were not receiving AML therapy.

Again, patients were more likely to assess transfusion independence as very important (46.2%) compared with physicians (39.3%). A majority (60.3%) of patients reported receiving ≥ 1 transfusion in the past 3 months with less than half (42.6%) reporting transfusions less than 4 times per month.

Among the 47 patients receiving transfusions in the last 3 months, 59.6% said QOL was at least somewhat affected. Activity was impaired due to transfusion 41.7% of the time, on average. Nearly all the US-based patients (94.6%) reported their monthly out-of-pocket transfusion costs were more than $500, with 43.2% reporting costs were more than $2000.

The authors similarly concluded that there are humanistic and economic benefits for these patients to have maintenance therapies for AML that decrease transfusions after HSCT.

“Although few patients received transfusions, transfusions negatively impacted patient QOL and the ability to participate in daily activities,” they wrote.

References

1. Yang H, Zhou M, Marshall DA, et al. Impact of blood transfusions on treatment attributes, quality of life (QoL), and out-of-pocket (OOP) costs in newly diagnosed acute myeloid leukemia (AML) ineligible for high-intensity chemotherapy (HIC): patient and physician perspectives. Presented at: AMCP Nexus 2021; Denver, Colorado; October 18-21, 2021. Poster C40.

2. Zhou M, Yang H, Song Y, et al. Patient and physician perspectives on treatment attributes and the humanistic and economic burden of blood transfusions in patients with acute myeloid leukemia (AML) previously treated with hematopoietic stem cell transplantation (HSCT). Presented at: AMCP Nexus 2021; Denver, Colorado; October 18-21, 2021. Poster C46.