A Multicenter Study of Platelet Recovery and Utilization in Patients After Myeloablative Therapy and Hematopoietic Stem Cell Transplantation

Abstract

An observational study was conducted at 18 transplant centers in the United States and Canada to characterize the platelet recovery of patients receiving myeloablative therapy and stem cell transplantation and to determine the clinical variables influencing recovery, determine platelet utilization and cost, and incidence of hemorrhagic events. The study included 789 evaluable patients transplanted in 1995. Clinical, laboratory, and outcome data were obtained from the medical records. Variables associated with accelerated recovery in multivariate models included (1) higher CD34 count; (2) higher platelet count at the start of myeloablative therapy; (3) graft from an HLA-identical sibling donor; and (4) prior stem cell transplant. Variables associated with delayed recovery were (1) prior radiation therapy; (2) posttransplant fever; (3) hepatic veno-occlusive disease; and (4) use of posttransplant growth factors. Disease type also influenced recovery. Recipients of peripheral blood stem cells (PBSC) had faster recovery and fewer platelet transfusion days than recipients of bone marrow (BM). The estimated average 60-day platelet transfusion cost per patient was $4,000 for autologous PBSC and $11,000 for allogeneic BM transplants. It was found that 11% of all patients had a significant hemorrhagic event during the first 60 days posttransplant, contributing to death in 2% of patients. In conclusion, clinical variables influencing platelet recovery should be considered in the design and interpretation of clinical strategies to accelerate recovery. Enhancing platelet recovery is not likely to have a significant impact on 60-day mortality but could significantly decrease health care costs and potentially improve patient quality of life.

Recombinant Human Thrombopoietin Promotes Platelet Engraftment and Improves Prognosis of Patients with Myelodysplastic Syndromes and Aplastic Anemia after Allogeneic Hematopoietic Stem Cell Transplantation

“…PPGF was associated with shorter survival time, which is consistent with the previous studies [4,8,11,12]. Numerous studies have reported risk factors that influence platelet engraftment, such as myelotoxic agent, conditioning regimen intensity, stem cell source, and number of infused CD34 + cells or MNC [5,6,11,28]. Consistent with previous studies, our findings indicate that the CD34 + cell dose is crucial for better platelet engraftment [29,30].…”

Impact of platelet transfusion on toxicity and mortality after hematopoietic progenitor cell transplantation

“…To our knowledge, no other studies have correlated PLT transfusion requirements with global markers of adverse clinical outcomes after HPCT such as NRM and all‐cause ICU admission. One study by Bernstein and colleagues, however, examined PLT use and time to PLT engraftment in patients undergoing HSCT and identified several baseline patient characteristics that are associated with increased transfusion needs and longer time to PLT recovery. Consistent with our findings, they reported that allogeneic transplant recipients received a higher number of PLT transfusions and had a longer time to PLT recovery.…”

“…Consistent with our findings, they reported that allogeneic transplant recipients received a higher number of PLT transfusions and had a longer time to PLT recovery. Interestingly, most clinically significant bleeding events occurred when the morning PLT count was more than 20 ×10 9 /L and other transplant‐related variables such as mucositis, cystitis, and graft‐versus‐host disease were more significant predictors of bleeding risk than PLT count . Undoubtedly, patient factors such as underlying malignancy and extent of prior treatment and the intensity of the transplant conditioning regimen influence patient transfusion requirements and larger studies performed in a prospective fashion in more homogenous patient populations may provide greater insight.…”

The hematopoietic cell transplantation‐specific comorbidity index (HCT‐CI) is an outcome predictor for partially matched related donor transplantation

“…In our study, we also found that the platelet engraftment was poorer for patients with HCT‐CI scores of ≥3 ( P = 0.033). We speculate that this might be the result of direct damage of comorbidities on the marrow microenvironment , or that it might result from increases in a negative regulator of hematopoiesis, such as TNF‐α and IL‐6 . Therefore, a high comorbidity burden may well affect the platelet engraftment negatively.…”