Transfusion Use Among Children With Hematologic Malignancies Receiving Concurrent Hospice Care.

Abstract

Patients with hematologic malignancies enroll in hospice at lower rates than other diagnoses, potentially due to loss of transfusion support. This study evaluated transfusion use among children with hematologic cancers enrolled in home-based hospice programs designed to maintain transfusion availability. This three-year retrospective review included patients <21 years with hematologic malignancies enrolled in hospice between October 2022 and 2025. Structured query language reports and manual chart reviews captured demographic and clinical data. Thirty-six patients (mean 10.9 years [range 1-19]) were included, with an average hospice duration of 174 days (8-763). Patients received a mean of 88.6 platelet (0-330) and 32.4 red blood cell (0-120) transfusions. Transfusion frequency did not differ by demographics but was higher among international patients (P = 0.021). Acute myeloid leukemia was associated with higher transfusion use compared with other diagnoses (P = 0.015). Longer hospice enrollment correlated with higher number of transfusions across settings (P < 0.05). Children living in institutional housing received transfusions closer to death compared to community-based patients (P = 0.017). Timing of last chemotherapy predicted timing of last transfusion (P < 0.001). In a setting with guaranteed transfusion access, children commonly continued transfusions throughout hospice, supporting symptom-focused care.