***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Insight regarding transfusion practice s in Hematopoietic Stem cell Transplantation ( HSCT ) are lacking and the impact of red cell transfusion in this high risk group on outcomes following HSCT are not well appreciated . Red blood cell transfusion can be life-saving , however , liberal use of transfusion in critically ill patients failed to demonstrate significant clinical benefit . A large number of other observational studies have also demonstrated an association between red blood cell transfusions and increased morbidity such as infections and multi organ failure as well as increased mortality . The role of red cell transfusion on the clinical outcomes observed in patients undergoing HSCT remains poorly understood and a prospect i ve r and omized study of transfusion is required to gain insight and knowledge on best transfusion practice s in this high risk population . Methods This report describes the design and method ological issues of a r and omized pilot study evaluating red cell transfusion triggers in the setting of Hematopoietic Stem Cell Transplantation . This study has been funded by a peer review grant from the Canadian Blood Services and is registered on Clinical trials.gov NCT01237639 . Results In 3 Canadian centres , 100 patients undergoing Hematopoietic Stem Cell Transplantation will be r and omized to either a restrictive ( target hemoglobin of 70 - 90 g/L ) or liberal ( target hemoglobin of 90 - 110 g/L ) red cell transfusion strategy , based daily hemoglobin values up to 100 days post-transplant . The study will stratify participants by centre and type of transplant . The primary goal is to demonstrate study feasibility and we will collect clinical outcomes on 1 ) Transfusion Requirements , 2 ) Transplant Related Mortality , 3 ) Maximum grade of acute Graft versus Host Disease , 4 ) Veno-occlusive Disease , 5 ) Serious Infections , 6 ) Bearman Toxicity Score , 7 ) Bleeding , 8) Quality of Life , 9 ) Number of Hospitalizations and 10 ) Number of Intensive Care Unit ( ICU ) Admissions . Conclusion Upon completion , this pilot trial will provide preliminary insight into red cell transfusion practice and its influence in hematopoietic stem cell transplant outcomes . The results of this trial will inform the conduct of a larger study Baseline characteristics , disease‐management and outcome of 1000 lower‐risk myelodysplastic syndrome ( MDS ) patients within the European LeukaemiaNet MDS ( EUMDS ) Registry are described in conjunction with the validation of the revised International Prognostic Scoring System ( IPSS‐R ) . The EUMDS registry confirmed established prognostic factors , such as age , gender and World Health Organization 2001 classification . Low quality of life ( EQ‐5D visual analogue scale score ) was significantly associated with reduced survival . A high co‐morbidity index predicted poor outcome in univariate analyses . The IPSS‐R identified a large group of 247 patients with Low ( 43 % ) and Very low ( 23 % ) risk score within the IPSS intermediate‐1 patients . The IPSS‐R also identified 32 High or Very high risk patients within the IPSS intermediate‐1 patients . IPSS‐R was superior to the IPSS for predicting both disease progression and survival . Seventy percent of patients received MDS‐specific treatment or supportive care , including red blood cell transfusions ( 51 % ) , haematopoietic growth factors ( 58 % ) and iron chelation therapy ( 8 % ) , within 2 years of diagnosis ; while 30 % of the patients only required active monitoring . The IPSS‐R proved its utility as a more refined risk stratification tool for the identification of patients with a very good or poor prognosis and in this lower‐risk MDS population BACKGROUND To determine whether a restrictive strategy of red-cell transfusion and a liberal strategy produced equivalent results in critically ill patients , we compared the rates of death from all causes at 30 days and the severity of organ dysfunction . METHODS We enrolled 838 critically ill patients with euvolemia after initial treatment who had hemoglobin concentrations of less than 9.0 g per deciliter within 72 hours after admission to the intensive care unit and r and omly assigned 418 patients to a restrictive strategy of transfusion  , in which red cells were transfused if the hemoglobin concentration dropped below 7.0 g per deciliter and hemoglobin concentrations were maintained at 7.0 to 9.0 g per deciliter , and 420 patients to a liberal strategy  , in which transfusions were given when the hemoglobin concentration fell below 10.0 g per deciliter and hemoglobin concentrations were maintained at 10.0 to 12.0 g per deciliter . RESULTS Overall , 30-day mortality was similar in the two groups ( 18.7 percent vs. 23.3 percent , P= 0.11 ) . However , the rates were significantly lower with the restrictive transfusion strategy among patients who were less acutely ill -- those with an Acute Physiology and Chronic Health Evaluation II score of < or = 20 ( 8.7 percent in the restrictive- strategy group and 16.1 percent in the liberal- strategy group ; P=0.03 ) -- and among patients who were less than 55 years of age ( 5.7 percent and 13.0 percent , respectively ; P=0.02 ) , but not among patients with clinical ly significant cardiac disease ( 20.5 percent and 22.9 percent , respectively ; P=0.69 ) . The mortality rate during hospitalization was significantly lower in the restrictive- strategy group ( 22.3 percent vs. 28.1 percent , P=0.05 ) . CONCLUSIONS A restrictive strategy of red-cell transfusion is at least as effective as and possibly superior to a liberal transfusion strategy in critically ill patients , with the possible exception of patients with acute myocardial infa rct ion and unstable angina Previous studies have shown that maintaining high hemoglobin levels in patients after chemotherapy  reduced the length of neutropenia . Thus , we undertook a r and omized , controlled , clinical trial in children undergoing allogeneic bone marrow transplantation after receiving a myeloablative conditioning regimen  to compare 2 hemoglobin thresholds as triggers for red blood cell transfusion : 120 g/L in the experimental arm and 70 g/L in the control arm . The Data and Safety Monitoring Board closed the study after enrollment of the sixth patient because 3 patients in the experimental arm contracted veno-occlusive disease , but none in the control arm did ( P = .05 ) . Ascites was present in all 3 patients , pleura effusion in 2 , and portal vein thrombosis in 2 . One patient experienced hepatic failure and required treatment with the molecular adsorbent recycling system . Another patient required hemodialysis for renal failure . No major imbalance between groups was seen with regard to risk factors for veno-occlusive disease . Therefore , maintaining the hemoglobin at higher levels should be avoided after hematopoietic stem cell transplantation OBJECTIVE Anaemia in low-risk myelodysplastic syndromes ( MDS ) is associated with reduced quality of life ( QoL ) . Response to treatment with erythropoietin ± granulocyte colony-stimulating factor ( G-CSF ) is associated with improved QoL , but whether transfusion therapy with higher haemoglobin ( Hb ) target levels has similar effects is unknown . The objective for this prospect i ve phase II Nordic multicentre trial was to assess QoL , response rate and physical function in elderly anaemic MDS patients treated to a target Hb level of > 120 g/L. METHODS Thirty-six elderly patients with low- and intermediate-1 risk MDS  received darbepoetin ( DA ) 300 μg/wk , with the addition of G-CSF if no response . If the Hb target was reached at 16 wk , treatment was maintained until week 26 . Remaining patients were transfused to reach the target level for at least 8 wk . RESULTS Twenty-seven patients completed the study . Response rate to DA ± G-CSF  was 67 % in evaluable patients and 56 % according to intention to treat . Eighteen patients reached the target Hb level according to protocol . QoL scores for fatigue , dyspnoea , constipation , and physical , role and social functioning improved significantly during study , with similar results for transfused and untransfused patients . Maintaining Hb > 120 g/L did not confer a higher transfusion rate , once the target was reached . In two of fourteen patients , magnetic resonance imaging T2 * indicated cardiac iron overload , however , without association with ferritin levels . CONCLUSIONS In elderly anaemic MDS patients , an increment in haemoglobin is associated with improved QoL , whether induced by growth factor treatment or transfusion therapy BACKGROUND Anemia may be an important factor contributing to an increased risk of bleeding , particularly in patients with thrombocytopenia . STUDY DESIGN AND METHODS A multicenter , single-blinded pilot r and omized controlled trial ( RCT ) was performed to evaluate the feasibility of conducting a larger RCT to determine the effect of the hemoglobin ( Hb ) concentration on bleeding risk .  Patients with acute leukemia receiving induction chemotherapy or those undergoing stem cell transplantation were assigned to one of two treatment groups : st and ard transfusion strategy ( transfusion of 2 units of red blood cells [ RBCs ] when their Hb level was less than 80 g/L ) or an augmented transfusion strategy ( transfusion of 2 units of RBCs when their Hb level was less than 120 g/L ) . RESULTS Sixty patients were enrolled : 29 in the control group and 31 in the experimental group . The proportions of patients experiencing clinical ly significant bleeding and the time to first bleed were not significantly different between the control and experimental groups . The experimental group received more  RBC transfusions  ( transfusions/patient-day ) than the control group ( 0.233 vs. 0.151 ; relative risk , 1.56 ; 95 % confidence interval , 1.16 - 2.10 ; p = 0.003 ) . The proportion of patient-days with platelet ( PLT ) transfusions was not different between the experimental and control groups . The mean number of donor exposures ( PLT and RBC transfusions ) was not different between experimental and control groups . Bleeding symptoms were systematic ally documented . CONCLUSION This pilot study thus indicated that it would be feasible to enroll the required number of patients to enable the performance of a large RCT to investigate the effect of Hb on bleeding risk in thrombocytopenic patients Patients with hematologic malignancies undergoing allogeneic stem cell transplantation ( HSCT )  commonly have an elevated serum ferritin prior to HSCT , which has been associated with increased mortality after transplantation . This has led to the suggestion that iron overload is common and deleterious in this patient population . However , the relationship between serum ferritin and parenchymal iron overload in such patients is unknown . We report a prospect i ve study of 48 patients with acute leukemia ( AL ) or myelodysplastic syndromes ( MDS ) undergoing myeloablative HSCT , using magnetic resonance imaging ( MRI ) to estimate liver iron  content ( LIC ) and cardiac iron . The median ( and range ) pre-HSCT value of serum ferritin was 1549 ng/mL ( 20 - 6989 ) ; serum hepcidin , 59 ng/mL ( 10 - 468 ) ; labile plasma iron , 0 LPI units ( 0.0 - 0.9 ) . Eighty-five percent of patients had hepatic iron overload ( HIO ) , and 42 % had significant HIO ( LIC ≥5.0 mg/gdw ) . Only 1 patient had cardiac iron overload . There was a strong correlation between pre-HSCT serum ferritin and estimated LIC ( r = .75 ) , which was mostly dependent on prior transfusion history . Serum hepcidin was appropriately elevated in patients with HIO . Labile plasma iron elevation was rare . A regression calibration analysis supported the hypothesis that elevated pre-HSCT LIC is significantly associated with inferior post-HSCT survival . These results contribute to our underst and ing of the prevalence , mechanism , and consequences of iron overload in HSCT 
    Output:
    
This review indicates that there is currently a lack of evidence for the recommendation of a particular transfusion strategy for bone marrow failure patients undergoing supportive treatment only .