Use of fresh blood components during intensive combination therapy of childhood leukemia

The increasing demand and the expense of obtaining and dispensing fresh human blood components prompted this study of the actual quantities used during intensive combination therapy of childhood acute lymphocytic leukemia (ALL). All the platelet/leukocyte-rich plasma (PRP), fresh whole blood (FW-B), and packed red blood cells (RBC) given to 128 children from 1962–70 were tabulated. The transfusions were subdivided by status of patient's disease, stage of therapy, therapeutic regimen, and primary indication. During the entire period of remission induction and combination chemotherapy and radiotherapy, the average child was given 3.2 units of PRP and 2.5 transfusions of FWB and RBC. In contrast, over 20 PRP units and over six FWB and RBC transfusions were given to the average child during the period of experimental chemotherapy after hematologic relapse and to children who were remission-induction failures. The quantities given during each stage of disease in sequential therapeutic regimens were remarkably similar despite the 8-year span of study. We conclude that children with ALL receiving intensive combination therapy require relatively small quantities of fresh blood components and that most components are given after relapse during experimental chemotherapy.