Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: Randomized Multicenter Trial of Two Transfusion Strategies for Patient Receiving Chemotherapy for Acute Leukemia or Hematopoietic Stem Cells With Medico-economic Evaluation of Cost Minimization.
Brief Summary: Patients with acute hematological disease (acute leukemia, aplastic anemia, hematopoietic stem cells autologous or allogeneic ...) and hospitalized in an intensive care unit hematology require compensation of anemia and thrombocytopenia by blood transfusions of red blood packed cells (RBP) or platelet concentrates (PC).The AFSSAPS (Agence Française de Sécurité Sanitaire des Produits de Santé) recommendations (2002) specify the need to transfuse 2 RBP in case of symptomatic anemia usually for a hemoglobin between 6 and 10 g / dL. These recommendations allow to transfuse a single RBP for very elderly patients or in cases of associated heart disease (heart failure). A recent development (2012) on post-transfusion pulmonary edema overload recommends transfusion unit by unit for high risk patients.

More recently, a Swiss team has historically compared transfusion policies in 2 139 patients with hematological malignancies. The first group received 2 RBP transfusion in case of symptomatic anemia or hemoglobin level \<6 g / dL. The other group only received 1 RBP at each transfusion. In total 2212 units in 1548 transfusions were performed and the 1 RBP transfusion policy has resulted in a 25% decrease in the number of RBP used without any complication. In a prospective single-center pilot study, we showed that transfusing a single RBP was possible without increasing the side effects of anemia, without complications and allow an overall reduction in consumption of red blood cell units.

Several meta-analyzes reported in intensive care or bleeding situations that a restrictive use of transfusions significantly reduces cardiac events, bleeding, bacterial infections and mortality. The number of patient to be treated to prevent one death is 33.

The main objective is to demonstrate in a randomized trial that the restrictive strategy (transfusion of a single unit at each transfusion) is not inferior to the liberal strategy (transfusion of 2 unit at each transfusion) in terms of severe complication. Transfusion are performed in case of hemoglobin level \<8g/dL.

Key secondary objectives are to reduce the number of RBP used and the cost of hospitalization with a comparison of complications/mortality in the 2 groups.


Options:
A: Arm Label: Liberal Transfusion Strategy; Type: ACTIVE_COMPARATOR; Interventions: Other: Red blood cell transfusion | Arm Label: Restrictive Transfusion Strategy; Type: ACTIVE_COMPARATOR; Interventions: Other: Red blood cell transfusion | Intervention Type: OTHER; Name: Red blood cell transfusion; Assigned to Arm(s): Liberal Transfusion Strategy | Intervention Type: OTHER; Name: Red blood cell transfusion; Assigned to Arm(s): Restrictive Transfusion Strategy
B: Arm Label: Allowed drop in hemoglobin to 4.5-5.5 mmol/L; Type: ACTIVE_COMPARATOR; Interventions: Other: Allowed drop in hemoglobin to 4.5-5.5 mmol/L | Arm Label: Allowed drop in hemoglobin to 5.6-6.5 mmol/L; Type: EXPERIMENTAL; Interventions: Other: Allowed drop in hemoglobin to level between 5.6-6.5 mmol/L | Intervention Type: OTHER; Name: Allowed drop in hemoglobin to 4.5-5.5 mmol/L; Assigned to Arm(s): Allowed drop in hemoglobin to 4.5-5.5 mmol/L | Intervention Type: OTHER; Name: Allowed drop in hemoglobin to level between 5.6-6.5 mmol/L; Assigned to Arm(s): Allowed drop in hemoglobin to 5.6-6.5 mmol/L
C: Arm Label: ARM A; Type: ACTIVE_COMPARATOR; Interventions: Drug: Two packed red blood cells Transfusion | Arm Label: ARM B; Type: EXPERIMENTAL; Interventions: Drug: Single red blood packed cells Transfusion | Intervention Type: DRUG; Name: Single red blood packed cells Transfusion; Assigned to Arm(s): ARM B | Intervention Type: DRUG; Name: Two packed red blood cells Transfusion; Assigned to Arm(s): ARM A
D: Arm Label: Low transfusion threshold; Type: EXPERIMENTAL; Interventions: Biological: Red blood cell transfusion | Arm Label: High transfusion threshold; Type: ACTIVE_COMPARATOR; Interventions: Biological: Red blood cell transfusion | Intervention Type: BIOLOGICAL; Name: Red blood cell transfusion; Assigned to Arm(s): High transfusion threshold, Low transfusion threshold

Answer: C