Study of Red Blood Cell Transfusion Triggers in Patients Undergoing Hematopoietic Stem Cell Transplantation

NCT01237639 — Phase 3, Completed, 300 participants, Ottawa Hospital Research Institute

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Transfusion of Red Cells in Hematopoietic Stem Cell Transplantation: The TRIST Study

RegistryNCT01237639, acronym TRIST
StatusCompleted
PhasePhase 3
Study typeInterventional; randomized, parallel, masking: none, supportive care
Enrollment300 (Actual)
SponsorOttawa Hospital Research Institute (Other); collaborators: Canadian Blood Services, Canadian Institutes of Health Research (CIHR), The Ottawa Hospital, Hamilton Health Sciences Corporation, London Health Sciences Centre, Saskatchewan Cancer Centre
ConditionsHematologic Malignancies
InterventionsRed blood cell Transfusion (Other)
Datesstart 2011-03-01, primary completion 2016-10-01, completion 2016-10-01, first posted 2010-11-09, last updated 2016-10-12
Locations4 sites in Canada

Related Papers Related Patents Related Grants Related Experts
All trials for Hematologic Malignancies All trials of Red blood cell Transfusion

-Summary

Transfusion of red blood cells (RBCs) is important for the care of patients undergoing stem cell transplantation. Stem cell transplants are used to treat blood cancers and bone marrow disorders. This involves the use of high doses of chemotherapy and/or radiation to kill cancer cells; but this damages the marrow and blood system. Blood stem cells are transplanted by infusing into the recipient and blood counts recover over 2-3 weeks. Before bone marrow recovery, RBCs are needed to support the patient. Higher hemoglobin in these high risk patients may have benefits such as better energy and organ function. However, research in other areas of medicine suggests that a higher red cell count may be dangerous. Taken together, it is unclear whether having a lower or higher red cell count is better for patients having a blood stem cell transplant. The investigators plan to study this by randomly assigning patients having a transplant to be transfused with RBCs either at a higher or lower hemoglobin level. In this way, the investigators will be able to accurately find out if there are any benefits or harms in having a lower or higher red cell count during the recovery period after blood stem cell transplantation.

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+Detailed description

1. Males or females aged 18 years or older who are undergoing either an autologous or allogeneic HSCT.
2. The indications for HSCT may include, but not limited to the following diseases :

1. Acute Leukemia, myeloid, lymphoid or biphenotypic in 1st, 2nd remission or in relapse
2. Chronic Myeloid Leukemia in chronic, accelerated or blast phase
3. Chronic Lymphocytic Leukemia
4. Myelodysplastic Syndrome
5. Myeloproliferative Disorder
6. Lymphoma
7. Myeloma
3. All study patients must provide consent at least 1 day prior to scheduled HSCT and provide written informed consent.

+Arms and interventions

ArmTypeInterventionsDescription
Restrictive Red blood cell TransfusionExperimentalOther: Red blood cell TransfusionTransfusion Trigger of 70g/L with an aim to maintain Hemoglobin between 80-90g/L
Liberal Red blood Cell TransfusionActive comparatorOther: Red blood cell TransfusionTransfusion Trigger of 90g/L with an aim to maintain Hemoglobin between 100-110g/L
  • Red blood cell Transfusion (Other): Transfusion of Red blood cells to based on daily complete blood count

+Outcome measures

Primary outcomes

  • Quality of Life (QOL)/Function based on the FACT-BMT scale [3 years]: The FACT consists of 5 subscales that measure physical well-being, functional well-being, social/family well-being and emotional well-being. The BMT subscale of the FACT includes additional items specifically designed to test quality of life and symptoms specific to BMT patients.

Secondary outcomes

  • Transplant Related Mortality [100 days]
  • Red Cell Transfusion [100 days]
  • Platelet Transfusion [100 days]
  • Acute Graft Versus Host Disease [100 days]
  • Bleeding [100 days]: Grade 3 or 4 by WHO scale
  • Serious Infections [100 days]: All grade 4 and 5 infections (according to the CTCAE v.4)
  • Time to Non-relapse Mortality [100 days]
  • Economic Evaluation/Quality of Life [100 days]: EQ-5D
  • NCI Toxicity Scale [100 days]

+Eligibility

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Patients are aged 16-70 undergoing either an autologous or allogeneic HSCT for any hematologic malignancy

Exclusion Criteria:

* Pregnant or lactating at the time of enrollment
* Already received red cell transfusion after HSCT but prior to enrollment
* Unable/unwilling to provide informed consent.
* Patients receiving HSCT for non-malignancy

+Locations (4)

FacilityCityCountryStatus
Hamilton Health Sciences CentreHamilton, OntarioCanada
London Health Sciences Centre, University HospitalLondon, OntarioCanada
The Ottawa HospitalOttawa, OntarioCanada
Saskatchewan Cancer CentreSaskatoon, SaskatchewanCanada

+Publications

  • Tay J, Tinmouth A, Fergusson D, Allan D. Transfusion of red cells in hematopoietic stem cell transplantation (TRIST): study protocol for a randomized controlled trial. Trials. 2011 Sep 21;12:207. doi: 10.1186/1745-6215-12-207. PMID 21936907
  • Results publication: Carson JL, Stanworth SJ, Dennis JA, Fergusson DA, Pagano MB, Roubinian NH, Turgeon AF, Valentine S, Trivella M, Doree C, Hebert PC. Transfusion thresholds and other strategies for guiding red blood cell transfusion. Cochrane Database Syst Rev. 2025 Oct 20;10(10):CD002042. doi: 10.1002/14651858.CD002042.pub6. PMID 41114449
  • Results publication: Carson JL, Stanworth SJ, Dennis JA, Trivella M, Roubinian N, Fergusson DA, Triulzi D, Doree C, Hebert PC. Transfusion thresholds for guiding red blood cell transfusion. Cochrane Database Syst Rev. 2021 Dec 21;12(12):CD002042. doi: 10.1002/14651858.CD002042.pub5. PMID 34932836
  • Results publication: Tay J, Allan DS, Chatelain E, Coyle D, Elemary M, Fulford A, Petrcich W, Ramsay T, Walker I, Xenocostas A, Tinmouth A, Fergusson D. Liberal Versus Restrictive Red Blood Cell Transfusion Thresholds in Hematopoietic Cell Transplantation: A Randomized, Open Label, Phase III, Noninferiority Trial. J Clin Oncol. 2020 May 1;38(13):1463-1473. doi: 10.1200/JCO.19.01836. Epub 2020 Feb 21. PMID 32083994

+Investigators