Blood Transfusions During Nivolumab Linked to Worse Survival in Metastatic NSCLC
Posted: Tuesday, July 14, 2026
Erythrocyte suspension transfusions administered during nivolumab treatment were associated with shorter progression-free survival and overall survival in patients with metastatic non–small cell lung cancer (NSCLC), according to a retrospective study published in Technology in Cancer Research & Treatment. The association was predominantly driven by patients with nonsquamous histology, according to the study authors, including corresponding author Alper Coskun, MD, of the Department of Medical Oncology, Bursa Uludağ University, Turkey.
The single-center study retrospectively analyzed 88 patients with metastatic NSCLC who received nivolumab between January 2018 and December 2023. Transfusion status, baseline inflammatory markers, progression-free survival, and overall survival were evaluated using Kaplan–Meier analysis and univariable statistical methods.
The median progression-free survival was 5.93 months, and the median overall survival was 8.23 months in the full cohort. Patients who received erythrocyte suspension transfusions during nivolumab experienced significantly shorter progression-free survival (P = .033) and overall survival (P = .039). When stratified by histological subtype, this association persisted in the nonsquamous subgroup (P-value for progression-free survival = .002; P-value for overall survival = .008), but not in the squamous subgroup. Notably, erythrocyte suspension transfusions administered before or after nivolumab did not significantly affect progression-free survival or overall survival.
In univariable analyses, several baseline inflammatory and nutritional markers—including nivolumab cycle count, pre-treatment hemoglobin, neutrophil-to-lymphocyte ratio, C-reactive protein-to-albumin ratio, and systemic immune-inflammation index—were associated with progression-free survival. Similar factors, along with programmed cell death ligand-1 levels and prognostic nutritional index, were associated with overall survival.
The authors acknowledged that a multivariable Cox regression analysis could not be performed due to the limited number of events. They noted that these findings should be interpreted with caution, given the retrospective design and that erythrocyte suspension transfusion “should be interpreted primarily as a marker of clinical deterioration rather than a direct causal factor influencing survival.” They called for larger, prospective multicenter studies to validate these associations.
Disclosure: The study authors reported no conflicts of interest.
