Home-based transfusions in hospice patients with hematologic malignancies: a pilot study

Background Hospice care (HC) for patients with hematologic malignancies (HM) is underutilized due to concerns about cessation of blood transfusions. Home-based transfusion (HBT) programs have proven to be safe, but little research exists for HM patients in HC. We hypothesized that HBT protocol could be safely implemented to reduce symptoms burden, lengthen life expectancy and improve quality of life in HC. Methods In a non-randomized pilot study between 8/2020 and 7/2023, adult transfusion-dependent HM patients were offered weekly transfusion of one unit of packed red blood cells (PRBC) and/or one unit of platelets based on symptoms criteria, not lab values. Exclusion criteria included prior transfusion reactions, extended blood typing, or residence outside 50 miles from the transfusion center. Hospice agencies provided management and support, while Our Blood Institute (OBI) provided palliative HBT. Symptom scores and complete blood counts (CBC) were collected weekly, and EORTC QLQ-C30 quality of life (QOL) questionnaire was completed before and after transfusions. The primary feasibility and safety outcomes were recruitment, ability to administer indicated transfusions, and transfusion reactions. The study was registered with ClinicalTrials.gov (NCT04454723) on 6/30/2020. Findings We enrolled 21 patients (mean age in years=67.1 (standard deviation (SD) = 14.4); 100% enrollment, one withdrew consent). Participants received an average of 3.4 units (SD = 3.4) of platelets or PRBCs. No transfusion reactions reported. Mean cost was $571 per week (SD = $939). The EORTC Composite Score least squares-mean difference (post-pre- transfusion) increased 0.18 (SE = 1.88) (p-value = 0.92) but not significantly. Median hospice duration was 11 days, IQR=8–40 days, 95% CI: 9–33 days. All patients died at home, with no hospitalizations or intensive care unit (ICU) admissions. Interpretation HBT, in the setting of hospice represents a feasible and safe option for further study to avoid costly hospitalizations and ICU admissions, with limited cost. This trial demonstrates proof of concept for an economical, patient-centered HBT protocol in HM patients receiving HC.