Transfusion Use Among Children With Hematologic Malignancies Receiving Concurrent Hospice Care.
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BACKGROUND: Patients with hematologic malignancies enroll in hospice at lower rates than other diagnoses, potentially due to loss of transfusion support. OBJECTIVE: This study evaluated transfusion use among children with hematologic cancers enrolled in home-based hospice programs designed to maintain transfusion availability. METHODS: 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. RESULTS: 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). CONCLUSIONS: In a setting with guaranteed transfusion access, children commonly continued transfusions throughout hospice, supporting symptom-focused care.