Efficacy of prophylactic transfusions using single donor apheresis platelets versus pooled platelet concentrates in AML/MDS patients receiving allogeneic hematopoietic stem cell transplantation

Abstract

Superiority of single-donor apheresis platelets (SDAP) over pooled platelet concentrates (PPC) transfusions is largely assumed, but unproven. We hypothesized that prophylactic SDAP and PPC transfusions are clinically equivalent after allogeneic hematopoietic stem cell transplants (HSCT). We studied all transfusions administered to 33 patients with AML/MDS during the first 100 days after busulfan-based, myeloablative HSCT. All donorrecipient pairs were ABO identical. Transfusion threshold was a platelet count p15 Â 10 9 /l. The corrected increment (CCI) was used for all comparisons. Median time to platelet engraftment was 13 days (n ¼ 30). PPC transfusions (n ¼ 105) were ABO compatible, while 10% of 41 SDAP were not (P ¼ 0.006). Median post-transfusion platelet count was 51K/ll (5-118K) after SDAP and 36K/ll (3-115K) after PPC (P ¼ 0.0004). Median CCI was 14.178 (SDAP) versus 7.793 (PPC) (P ¼ 0.0001). Median time to another transfusion was 3 days (SDAP) and 2 days (PPC; P ¼ 0.3). In the week following any given transfusion, the median number of new transfusions was similar (n ¼ 2), as well as the need of further transfusion (16 versus 24%, P ¼ 0.2). A total of 17% of SDAP and 30% of PPC transfusions were labeled 'ineffective' (P ¼ 0.1). There were two non-lethal hemorrhage episodes (6%). SDAP transfusions produced better platelet counts, but SDAP and PPC were equally effective in preventing hemorrhage.

A General Change of the Platelet Transfusion Policy from Apheresis Platelet Concentrates to Pooled Platelet Concentrates is Associated with a Sharp Increase in Donor Exposure and Infection Rates

“…of studies that describe a significantly better corrected count increment (CCI) in A-PC recipients regardless of A-PCs were compared to P-PCs prepared by the PRP method or by the BC method that is more common in Europe [11][12][13]. Consistent to this finding were longer transfusion intervals [13] and lower rates of patients refractory to further platelet transfusions [12].…”

Transfusion effect of random donor platelet and single donor platelet in thrombocytopenic patients at tertiary care hospital of South Gujarat

“…This study also comparable with present study in all aspects except one matter, CCI was comparable in both the groups (SDP and RDP transfusions) in present study. 10 Paul N et al stated that SDP offers major advantages over PC for most of the issues, particularly when improved patient care is given primary emphasis.…”

Wissenschaftliche Erläuterungen zur Stellungnahme „Bewertung von Apherese- und Pool-Thrombozytenkonzentraten“ des AK Blut vom 31.03.2015

“…Eine Aktualisierung des systematischen Reviews der Cochrane Gesellschaft [94] [57,[104][105][106][107][108][109][110][111][112]. Auch das Intervall bis zur nächsten Transfusion unterschied sich nicht [111].…”

“…Auch das Intervall bis zur nächsten Transfusion unterschied sich nicht [111]. Eine Studie mit kleiner Fallzahl bei AML-Patienten nach Stammzelltransplantation zeigte höhere Thrombozytenzahlen nach ATK-Transfusion, aber keinen signifikanten Unterschied der Blutungskomplikationen [109].…”