{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T04:27:42Z","timestamp":1787372862452,"version":"build-2736575974"},"reference-count":44,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Transfusion-related immunomodulation (TRIM) is a recognized immunosuppressive phenomenon whose interaction with immune checkpoint blockade remains poorly defined. We evaluated the impact of erythrocyte suspension transfusion on survival and immune-related toxicity in patients with metastatic non-small cell lung cancer (NSCLC) treated with nivolumab. Materials and Methods: This retrospective, multicenter study included 253 patients with metastatic NSCLC treated with nivolumab across five centers between April 2018 and March 2025. Patients who received a transfusion within three months before or during nivolumab therapy were compared with non-transfused patients. Survival was assessed using Kaplan\u2013Meier and Cox regression analyses. Results: Forty-two patients (16.6%) received transfusion. Transfused patients had significantly shorter progression-free survival (PFS) (median 3.6 vs. 9.3 months; HR = 2.28, 95% CI 1.47\u20133.56, p &lt; 0.001) and overall survival (OS) (median 5.8 vs. 16.3 months; HR = 2.76, 95% CI 1.86\u20134.11, p &lt; 0.001). In multivariable analysis, transfusion was an independent predictor of both shorter PFS (HR = 2.288, 95% CI 1.470\u20133.561, p &lt; 0.001) and shorter OS (HR = 2.351, 95% CI 1.565\u20133.533, p &lt; 0.001), independent of transfusion volume. No statistically significant association was detected between transfusion status and the incidence of nivolumab-related toxicity (p = 0.585), although this analysis was likely underpowered, whereas nivolumab-related toxicity was an independent favorable prognostic factor. Conclusions: Erythrocyte transfusion independently predicted poorer survival but not immune-related toxicity in nivolumab-treated metastatic NSCLC, supporting more judicious transfusion practices during immunotherapy.<\/jats:p>","DOI":"10.3390\/medicina62081601","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T16:05:19Z","timestamp":1787241919000},"page":"1601","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Erythrocyte Transfusion as an Independent Predictor of Survival but Not Immune-Related Toxicity in Nivolumab-Treated Metastatic NSCLC: A Multicenter Cohort"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-8199-4153","authenticated-orcid":false,"given":"Mehmet Cem","family":"Fidan","sequence":"first","affiliation":[{"name":"Division of Medical Oncology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul 34098, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ebru","family":"\u00c7i\u00e7ek","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul 34098, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1227-9996","authenticated-orcid":false,"given":"Hamza","family":"Abbasov","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul 34098, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2981-8098","authenticated-orcid":false,"given":"Murad","family":"Guliyev","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul 34098, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8263-0692","authenticated-orcid":false,"given":"Emir","family":"\u00c7erme","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul 34098, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5851-0239","authenticated-orcid":false,"given":"K\u00fcbra","family":"Akkaya","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Prof. Dr. Cemil Tasc\u0131oglu City Hospital, University of Health Sciences, Istanbul 34360, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bekir","family":"Do\u011fan","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul 34147, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2575-5819","authenticated-orcid":false,"given":"Nargiz","family":"Majidova","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, VM Medical Park Maltepe Hospital, Istanbul 34846, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burak","family":"Pa\u00e7ac\u0131","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul 34899, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3846-7047","authenticated-orcid":false,"given":"Ezgi","family":"T\u00fcrko\u011flu","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Kartal Dr. Lutfi Kirdar City Hospital, Health Science University, Istanbul 34865, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4507-5925","authenticated-orcid":false,"given":"Merve","family":"Ekinci Fidan","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul 34025, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emir","family":"\u00c7elik","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Topkapi Liv Hospital, Istinye University, Istanbul 34010, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1466-3887","authenticated-orcid":false,"given":"Mesut","family":"Y\u0131lmaz","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul 34147, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0130brahim Vedat","family":"Bayo\u011flu","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul 34899, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6zkan","family":"Alan","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul 34098, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nebi Serkan","family":"Demirci","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul 34098, 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