Condition category
Date applied
Date assigned
Last edited
Prospectively registered
Overall trial status
Recruitment status
No longer recruiting
Publication status
Results overdue

Contact information



Primary contact

Mrs Heather Smethurst


Contact details

NHSBT - Clinical Trials Unit
Long Road
United Kingdom
01223 588110 (48110)

Additional identifiers

EudraCT number number

Protocol/serial number


Study information

Scientific title

Red blood cell transfusion thresholds and Quality of Life in myelodysplastic syndromes: a pilot, feasibility study



Study hypothesis

This pilot trial aims to find out if giving red blood cell transfusions to reach a higher haemoglobin concentration is possible, safe and would improve quality of life in patients with myelodysplastic syndromes (MDS). The results may help design a large multi-centre randomised, controlled trial to be conducted in the future, or may show that it is not possible to carry out such a trial.

Ethics approval

NRES Committee South Central - Oxford A, 11/09/2014, ref. 14/SC/1150

Study design

Randomised; Interventional; Design type: Not specified, Treatment

Primary study design


Secondary study design

Randomised controlled trial

Trial setting


Trial type


Patient information sheet

Not available in web format, please use contact details to request a patient information sheet


Topic: Cancer; Subtopic: Haematological Oncology; Disease: Myelodysplastic syndromes


Transfusion Strategy, Eligible, informed and consented patients will be randomised to one of two red cell transfusion strategies:
1. Restrictive transfusion strategy to maintain haemoglobin concentration level between 85 and 100g/L; where 2 units of packed red cell unit transfusions are transfused when the haemoglobin concentration level is < 80g/L and 1 unit of packed red cell unit transfusions when haemoglobin concentration level is 80-85g/L.
2. Liberal transfusion strategy to maintain haemoglobin concentration; Study Entry : Single Randomisation only

Intervention type



Drug names

Primary outcome measure

The primary outcomes of this feasibility study, from day 0 to day 84, will be:
1. The percentage compliance of pre-transfusion haemoglobin concentrations being within or above the target range of the red cell transfusion threshold assigned
2. Achievement of at least a 20 g/L difference between the mean pre-transfusion haemoglobins in the liberal and restrictive strategy groups

Secondary outcome measures

1. Number of patients ineligible due to screening failure or workload of department
2. Enrolment rates defined as number of patients enrolled per month, number of replaced patients and patient tolerability of study schedule
3. Percentage compliance with completing the QoL questionnaires at scheduled study visits
4. Ability of patients to remain blinded to the treatment arm
5. Proportion of transfusions and proportion of patients with all transfusions given correctly, according to the algorithm
6. Percentage of pre-transfusion haemoglobin concentrations falling below, within and above the target range of the red cell transfusion threshold assigned
7. The magnitude of change in physical functioning, fatigue, dyspnoea and global health scores on the EORTC QLQ-C30 and calculated health utility on the EQ-5D comparing the two RBC transfusion thresholds, with clinically significant differences of 10 points for the QLQ-C30 and 0.08 points for the EQ-5D
8. Numbers of adverse events such as cardiac events and thromboembolic events, and transfusion reactions (as defined and adapted from SHOT definitions and as applied in other NHSBT CTU trials), per arm
9. The overall utilisation of blood during study period per group, to evaluate the amount of extra red cell units transfused/week/patient associated with the liberal strategy

Overall trial start date


Overall trial end date


Reason abandoned (if study stopped)


Participant inclusion criteria

1. All patients with MDS =18 years of age and with < 20% blasts on bone marrow aspirate (WHO classification), including non-proliferative CMML and other MDS/MPN overlap diseases. These patients will include both those recently diagnosed and with an established diagnosis
2. Transfusion dependent: at least 1 red cell transfusion episode per month in the last 8 weeks
3. Life expectancy >6 months

Participant type


Age group




Target number of participants

Planned Sample Size: 38; UK Sample Size: 38; Description: 19 Patients in each arm (restrictive vs liberal transfusion strategy)

Participant exclusion criteria

1 .Unable, in the opinion of the attending clinician, to tolerate restrictive or liberal red cell transfusion thresholds (e.g. clinically significant cardio-respiratory compromise)
2. Poor performance/functional status (Eastern Cooperative Oncology Group system ECOG =3)
3. Patients being actively treated with erythropiesis stimulating agents (ESAs) or disease modifying agents for their MDS (such as lenalidomide, azacitidine, hydroxycarbamide, experimental agents), as these may exert their own effects on the patients' quality of life and may render patients transfusion independent
4. Patients with myelofibrosis
5. Patients in whom the attending clinician considers that active bleeding or ongoing haemolysis contribute significantly to the cause of anaemia
6. Patients presenting with splenomegaly >5cm below the costal margin

Recruitment start date


Recruitment end date



Countries of recruitment

United Kingdom

Trial participating centre

National Blood Service –Oxford Centre
United Kingdom

Sponsor information


NHS Blood and Transplant (NHSBT)

Sponsor details

National R&D Office
500 North Bristol Park
BS34 7QH
United Kingdom

Sponsor type

Hospital/treatment centre



Funder type


Funder name

NHS Blood and Transplant (NHSBT) (UK)

Alternative name(s)

Funding Body Type

Funding Body Subtype


Results and Publications

Publication and dissemination plan

Not provided at time of registration

Intention to publish date

Participant level data

Not provided at time of registration

Basic results (scientific)

Publication list

Publication citations

Additional files

Editorial Notes

12/12/2018: The overall trial end date was changed from 31/12/2017 to 30/10/2018. 13/10/2016: Changed study contact details. Changed overall end date from 30/12/2016 to 31/12/2017. Changed recruitment end date from 31/07/2016 to 31/03/2017