Alternatives, and adjuncts, to prophylactic platelet transfusion for people with haematological malignancies undergoing intensive chemotherapy or stem cell transplantation

Abstract

There is insufficient evidence to determine if platelet-poor plasma or TPO mimetics reduce bleeding for participants with haematological malignancies undergoing intensive chemotherapy or stem cell transplantation. To detect a decrease in the proportion of participants with clinically significant bleeding from 12 in 100 to 6 in 100 would require a trial containing at least 708 participants (80% power, 5% significance). The six ongoing trials will provide additional information about the TPO mimetic comparison (424 participants) but this will still be underpowered to demonstrate this level of reduction in bleeding. None of the included or ongoing trials include children. There are no completed or ongoing trials assessing artificial platelet substitutes, fibrinogen concentrate, recombinant activated factor VII or desmopressin in people undergoing intensive chemotherapy or stem cell transplantation for haematological malignancies.

Alternative agents to prophylactic platelet transfusion for preventing bleeding in people with thrombocytopenia due to chronic bone marrow failure: a meta-analysis and systematic review

“…Sixty-seven were excluded (two review articles, 26 not RCTs, three incorrect intervention, 14 wrong participant group, four ongoing trials and 18 secondary citations of excluded studies). Seven trials that were excluded for being in the wrong participant group (Archimbaud 1999; Geissler 2003; Han 2015; Higby 1974; Miao 2012; Moskowitz 2007; Schiffer 2000) were included in a separate review assessing alternatives, and adjuncts, to prophylactic platelet transfusion for people with haematological malignancies undergoing intensive chemotherapy or stem cell transplantation (Desborough 2016b). In total, seven studies in 25 references were deemed eligible for inclusion (Fricke 1991; Giagounidis 2014; Greenberg 2013; Kantarjian 2010; Mannucci 1986; Platzbecker 2015; Wang 2012).…”

“…If subgroup data for participants with bone marrow failure were not available (even after contacting the authors of the trial), we excluded the trial if fewer than 80% of participants had bone marrow failure. We excluded any participants who did not have thrombocytopenia due to bone marrow failure, as well as participants undergoing intensive chemotherapy or stem cell transplantation, as this is the focus of another Cochrane review (Desborough 2016b). We included participants with bone marrow failure syndromes (e.g.…”

“…The review authors were not blinded to names of authors, institutions, journals, or the outcomes of the trials. A related review team had previously piloted the data extraction forms (Desborough 2016b). The two authors (MD, AH) independently extracted the following data for all the studies.…”

Platelet increment is not associated with endothelial damage in haematological patients: a prospective observational study

“…Modern chemotherapy, stem cell transplantation (STC) and oncologic irradiation therapies have increased the demand for platelet transfusions. Alternative therapies with platelet-poor plasma, artificial platelet substitutes, fibrinogen concentrate, desmopressin, recombinant activated factor VII or thrombopoietin have not been able to replace platelet transfusion as the first line of choice to treat or prevent bleeding in oncology/haematology patients with severe thrombocytopenia [2].…”

Successful hemostasis of an actively bleeding Dieulafoy’s lesion using only argon plasma coagulation in a patient with myelodysplastic syndrome and severe thrombocytopenia

“…With increase in hematological malignancies and frequency of intensive chemotherapy regimens that suppress the bone marrow, the incidence of severe thrombocytopenia has increased, according to most of the comprehensive meta-analyses (1). There are plenty of algorithms and recommendations for patients using anticoagulants and/or antiplatelet agents, in the guideline of European Society of Gastrointestinal Endoscopy and other similar guidelines.…”