{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T15:49:05Z","timestamp":1765381745223},"reference-count":39,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2011,1,16]],"date-time":"2011-01-16T00:00:00Z","timestamp":1295136000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2011,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Blood transfusion during acute lymphoblastic leukemia (ALL) of childhood is scarcely documented. Children with ALL are immunosuppressed by both the disease and its therapy. Transfusion may contribute to the course of ALL through its transfusion\u2010related immunomodulation (TRIM) effect.<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedure<\/jats:title><jats:p>Blood transfusion history and response to therapy for 108 children &lt;16 years of age at the time of ALL diagnosis was documented. Clinical files, electronic records, and blood bank registries were scrutinized. Overall survival (OS) and event\u2010free survival (EFS) in relation to blood product type and number of transfusions was determined. Hazard ratios (HR) for death and relapse were estimated through uni\u2010 and multivariate Cox regression analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One hundred eight ALL patients were included. Median age was 6 years (range: 0\u201315 years). Ninety\u2010seven patients (89.8%) were transfused. Median number of transfused products was seven (range: 0\u2010345). After multivariate analysis, transfusion of &gt;5 packed red blood cells (PRBC) remained a significant predictor for death (<jats:italic>P<\/jats:italic>\u2009=\u20090.003) and relapse (<jats:italic>P<\/jats:italic>\u2009=\u20090.011). For platelets, maximal significance was observed when &gt;30 platelet concentrates (PC) were transfused (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). When both, PRBC and PC were considered, maximal significance for predicting death was observed with transfusion of &gt;30 blood products (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The number of blood products transfused to children with ALL appears to be significantly associated with lower survival rates. This may reflect both the severity of the disease and the TRIM effect, which may decrease immune surveillance capacity and the probability of leukemic clone eradication. Pediatr Blood Cancer 2011; 57: 217\u2013223. \u00a9 2011 Wiley\u2010Liss, Inc.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.22957","type":"journal-article","created":{"date-parts":[[2011,1,16]],"date-time":"2011-01-16T14:10:27Z","timestamp":1295187027000},"page":"217-223","source":"Crossref","is-referenced-by-count":17,"title":["Is the number of blood products transfused associated with lower survival in children with acute lymphoblastic leukemia?"],"prefix":"10.1002","volume":"57","author":[{"given":"Jos\u00e9 Carlos","family":"Jaime\u2010P\u00e9rez","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Perla R.","family":"Colunga\u2010Pedraza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"G\u00f3mez\u2010Almaguer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2011,1,16]]},"reference":[{"key":"e_1_2_5_2_2","doi-asserted-by":"publisher","DOI":"10.1080\/10245330512331390447"},{"key":"e_1_2_5_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.blre.2007.07.003"},{"key":"e_1_2_5_4_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1537-2995.1995.351096026373.x"},{"key":"e_1_2_5_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.2005.00529.x"},{"key":"e_1_2_5_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(95)90627-4"},{"key":"e_1_2_5_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800790613"},{"key":"e_1_2_5_8_2","first-page":"246","article-title":"Transfusion and recipient immune function","volume":"113","author":"Blumberg N","year":"1989","journal-title":"Arch Pathol Lab Med"},{"key":"e_1_2_5_9_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1537-2995.1990.30790385527.x"},{"key":"e_1_2_5_10_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V93.5.1770"},{"key":"e_1_2_5_11_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V93.6.2033.406k18_2033_2037"},{"key":"e_1_2_5_12_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.seminhematol.2006.09.012"},{"key":"e_1_2_5_13_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1423-0410.2007.00954.x"},{"key":"e_1_2_5_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(197109)28:3<562::AID-CNCR2820280305>3.0.CO;2-P"},{"key":"e_1_2_5_15_2","first-page":"1220","article-title":"Transfusions and risk of failure in childhood acute lymphoblastic leukemia","volume":"8","author":"Freiberg A","year":"1994","journal-title":"Leukemia"},{"key":"e_1_2_5_16_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra023001"},{"key":"e_1_2_5_17_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2006-01-024729"},{"key":"e_1_2_5_18_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1996.14.1.18"},{"key":"e_1_2_5_19_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2141.2003.04738.x"},{"key":"e_1_2_5_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000539-199601000-00035"},{"key":"e_1_2_5_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(82)92764-7"},{"key":"e_1_2_5_22_2","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/90.8.573"},{"key":"e_1_2_5_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200007000-00035"},{"key":"e_1_2_5_24_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V84.6.1703.1703"},{"key":"e_1_2_5_25_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-3148.2000.00267.x"},{"key":"e_1_2_5_26_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.127.1.295"},{"key":"e_1_2_5_27_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1537-2995.1995.35395184274.x"},{"key":"e_1_2_5_28_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1537-2995.1994.34194098597.x"},{"key":"e_1_2_5_29_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1398-9995.1992.tb02385.x"},{"key":"e_1_2_5_30_2","doi-asserted-by":"publisher","DOI":"10.1186\/cc2847"},{"key":"e_1_2_5_31_2","doi-asserted-by":"publisher","DOI":"10.1097\/00024382-200116020-00005"},{"key":"e_1_2_5_32_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1423-0410.2008.01127.x"},{"key":"e_1_2_5_33_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.2006.00869.x"},{"key":"e_1_2_5_34_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12026-009-8106-9"},{"key":"e_1_2_5_35_2","doi-asserted-by":"publisher","DOI":"10.1182\/asheducation-2007.1.172"},{"key":"e_1_2_5_36_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.0041-1132.2004.00609.x"},{"key":"e_1_2_5_37_2","doi-asserted-by":"publisher","DOI":"10.1590\/S0104-42301997000300007"},{"key":"e_1_2_5_38_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.2009.02486.x"},{"key":"e_1_2_5_39_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1537-2995.2001.41050691.x"},{"key":"e_1_2_5_40_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.97.6.562"}],"container-title":["Pediatric Blood &amp; 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