New study below.
In preparation for my radical prostatectomy 12 years ago, I had two units of blood drawn (the maximum I was allowed), in case blood was needed during surgery. The surgeon told me that most RPs did not require blood. In any case, 2 units would be more than enough. Owing to "unusual blood vessels", both units were used.
I now discover, after reading the new paper, that my transfusion was "autologous" (own blood), & that the alternative would have been "allogeneic" (blood from the general supply).
"We found that allogeneic {perioperative blood transfusion} was significantly associated with decreased" biochemical recurrence-free survival, cancer-specific survival and overall survival."
"This provides further support for the immunomodulation hypothesis for allogeneic" perioperative blood transfusion.
No added risk from receiving one's own blood during surgery.
"Transfusion-related immunomodulation (TRIM), including alloimmunization, tolerance, and immunosuppression [1], has been postulated to explain the association between perioperative blood transfusion (PBT) and survival in a number of malignancies ..."
"Allogeneic PBT has been found to be the major cause of TRIM due to transfusion components that mediate immunosuppression, such as allogeneic mononuclear cells, immunosuppressive prostaglandins, soluble biologic response modifiers, and soluble human leukocyte antigen (HLA) Class I peptides ..."
-Patrick
Full text: journals.plos.org/plosone/a...
Abstract:
Purpose
There have been conflicting reports regarding the association of perioperative blood transfusion (PBT) with oncologic outcomes including recurrence rates and survival outcomes in prostate cancer. We aimed to evaluate whether perioperative blood transfusion (PBT) affects biochemical recurrence-free survival (BRFS), cancer-specific survival (CSS), and overall survival (OS) following radical prostatectomy (RP) for patients with prostate cancer.
Materials and Methods
A total of 2,713 patients who underwent RP for clinically localized prostate cancer between 1993 and 2014 were retrospectively analyzed. We performed a comparative analysis based on receipt of transfusion (PBT group vs. no-PBT group) and transfusion type (autologous PBT vs. allogeneic PBT). Univariate and multivariate Cox-proportional hazard regression analysis were performed to evaluate variables associated with BRFS, CSS, and OS. The Kaplan-Meier method was used to calculate survival estimates for BRFS, CSS, and OS, and log-rank test was used to conduct comparisons between the groups.
Results
The number of patients who received PBT was 440 (16.5%). Among these patients, 350 (79.5%) received allogeneic transfusion and the other 90 (20.5%) received autologous transfusion. In a multivariate analysis, allogeneic PBT was found to be statistically significant predictors of BRFS, CSS, and OS; conversely, autologous PBT was not. The Kaplan-Meier survival analysis showed significantly decreased 5-year BRFS (79.2% vs. 70.1%, log-rank, p = 0.001), CSS (98.5% vs. 96.7%, log-rank, p = 0.012), and OS (95.5% vs. 90.6%, log-rank, p < 0.001) in the allogeneic PBT group compared to the no-allogeneic PBT group. In the autologous PBT group, however, none of these were statistically significant compared to the no-autologous PBT group.
Conclusions
We found that allogeneic PBT was significantly associated with decreased BRFS, CSS, and OS. This provides further support for the immunomodulation hypothesis for allogeneic PBT.
