Effectiveness and Safety of Home-Based RBC Transfusions in Advanced Hematologic and Solid Tumors.

Abstract

Home-based red blood cell transfusion (RBC-TF) offers a potential treatment for terminally ill patients who suffer from anemia-related symptoms but face difficulties visiting medical facilities. However, its clinical utility and safety remain underexplored. To evaluate the effectiveness, safety, and procedural characteristics of home-based RBC-TF in terminally ill patients with hematological malignancies (HM) and solid tumors (ST). This retrospective study included patients with terminal-stage HM or ST who received home-based RBC-TF between July 2020 and February 2025. Symptom relief was used to assess effectiveness, and adverse events (AEs) were documented to evaluate safety. Biomarkers related to cancer cachexia were also analyzed. All transfusions followed standardized protocols, including premedication and the use of leukoreduced and irradiated RBCs. Seventy-seven patients (58 HM, 19 ST) received 1664 units of RBCs. Symptom improvement was significantly greater in HM patients compared to ST patients for fatigue (94.1% vs. 53.8%, P = 0.003) and appetite loss (55.0% vs. 6.7%, P = 0.004). No severe AEs were observed; two mild allergic reactions occurred (0.29%). ST patients exhibited more severe cachexia-related markers, including lower albumin and higher CRP levels. Home-based RBC-TF is a feasible and safe palliative intervention for carefully selected patients, especially those with HM. Standardized transfusion protocols may contribute to improved safety. Patient selection is essential, particularly in those with advanced cachexia who may experience limited benefit.