technologiesTechnologyStandard of care

Transfusion support and anaemia management

Red cell and platelet transfusions, iron and erythropoiesis-stimulating agents keep patients safe through chemotherapy and marrow failure; restrictive thresholds and ESA caution reflect trials showing more is not better.

Chemotherapy-induced anaemia affects most patients on myelosuppressive regimens; MDS and leukaemia patients are often transfusion-dependent. Evidence supports restrictive red cell thresholds (7-8 g/dL in stable patients; TRIST, Hb 7 vs 9 in haematologic malignancy) and prophylactic platelet transfusion at 10×10⁹/L (TOPPS showed prophylaxis still helps in most). ESAs (epoetin, darbepoetin) reduce transfusions but increased thromboembolism and mortality in several trials when Hb targets were high, so labels restrict them to palliative chemotherapy with Hb <10 g/dL (2007-08 FDA/EMA actions). IV iron improves ESA response and treats functional iron deficiency. Transfusional iron overload in MDS is treated with chelation (TELESTO). Newer agents: luspatercept and imetelstat (MDS), romiplostim/eltrombopag for chemotherapy-induced thrombocytopenia (off-label; avatrombopag trials), and thrombopoietin agonists after transplant. Blood supply and cost are limiting worldwide; pathogen-reduced platelets and cold-stored platelets are being adopted.

Generic schematic · not to scale · placeholder for the supportive care front

Structured aerobic + resistance

How it works

Replace or stimulate deficient blood components to prevent symptomatic anaemia, bleeding and infection while avoiding over-transfusion, alloimmunisation and ESA-related thrombosis.

Strengths

Life-saving in acute leukaemia and transplant
Restrictive strategies proven safe and cheaper
New MDS agents reduce transfusion burden

Limitations

Blood supply shortages, especially in LMICs
ESA safety restricts use
Iron overload and alloimmunisation with chronic transfusion

Products

2top

Not mapped hereTelomerase inhibitor (oligonucleotide)

Imetelstat · Rytelo

Imetelstat is the first telomerase-blocking drug approved for any cancer; it frees many lower-risk MDS patients from transfusions after growth factors have failed.

Not mapped hereErythroid maturation agent (activin receptor IIB ligand trap, Fc fusion)

Luspatercept · Reblozyl

An injection that helps the marrow finish making red cells, reducing or removing the need for transfusions in lower-risk MDS and beta-thalassaemia.