Association Between Transfusion Status and Overall Survival in Patients With Myelodysplastic Syndromes: A Systematic Literature Review and Meta-Analysis

Introduction: Multiple studies show transfusion independence (TI) in myelodysplastic syndrome (MDS) has a positive impact on overall survival (OS). To assess this, a systematic review and meta-analysis of the association between TI and OS in patients with MDS was conducted (PROSPERO ID: CRD42014007264). Methods: Comprehensive searches of five key bibliographic databases were conducted and supplemented with additional search techniques. Included studies recruited adults aged >18 years with MDS and examined the impact of transfusion status on OS. Results: 55 studies (89 citations) were included. The vast majority reported a statistically significant HR for OS in favour of TI patients, or patients who acquired TI after treatment. A random effects meta-analysis was conducted. Patients classed as TI at baseline showed a 59% decrease in the risk of death compared with transfusion dependent (TD) patients (HR 0.41; 95% credible interval (CrI): 0.29, 0.56), and this effect did not appear to interact significantly with illness severity (interaction coefficient HR 1.3895% CrI: 0.62, 3.41). Meta-analysis of studies where patients acquired TI was not possible, but consistently reported a survival benefit for those who acquired TI. Conclusion: The findings revealed a 59% pooled reduction in mortality among TI patients when compared with TD patients.