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.

Transplantation of a combination of CD133+ and CD34+ selected progenitor cells from alternative donors

“…Thus, the influence of G-CSF may be unlikely but cannot definitely be ruled out. Thirdly, it has been shown that a high CD34 + content of the graft is associated with faster recovery (Bernstein et al, 1998). This observation is in line with our mega dose concept, with the implication that high stem cell doses contribute to haematopoietic recovery.…”

“…Secondly, the use of growth factors has been reported to impair platelet recovery (Keever-Taylor et al, 2001). However, this effect is unclear and remains a subject of controversial discussions (Gisselbrecht et al, 1994;Bernstein et al, 1998). In this report, all patients with CD34 + selected grafts but only four of 10 patients of our CD133 + selected group received G-CSF.…”

Safety and Efficacy of Megakaryocytes Induced from Hematopoietic Stem Cells in Murine and Nonhuman Primate Models

“…Platelets play a crucial role in physiological hemostasis, and reduced platelet numbers lead to coagulation defects and uncontrollable bleeding [1][2][3]. Severe and prolonged thrombocytopenia frequently occurs in patients receiving high-dose chemotherapy or in those who undergo hematopoietic stem cell (HSC) transplantation [4,5]. At present, platelet transfusion is the primary method for protecting these patients from thrombocytopenic bleeding.…”

Platelet transfusion refractoriness

“…This requirement leads to lower average platelet survival with lower platelet counts as a consequence of the larger proportion of the platelet pool used to support baseline vascular integrity for thrombocytopenic patients. Platelet transfusions are necessary to prevent haemorrhagic complications after myeloablative therapy and haematopoietic stem cell transplantation (Bernstein et al, 1998) and failure to obtain an adequate level of circulating platelets adversely affects survival (Storb et al, 1983).…”