Platelet recovery and transfusion needs after reduced intensity conditioning allogeneic peripheral blood stem cell transplantation

Prébet, Thomas; Ladaique, Patrick; Ferrando, M.; Chabannon, Christian; Faucher, Catherine; Lavallade, Hugues de; El-Cheikh, Jean; Fürst, Sabine; Vey, Norbert; Stoppa, Anne‐Marie; Viens, Patrice; Blaise, Didier; Mohty, Mohamad

doi:10.1016/j.exphem.2009.10.004

Cited by 15 publications

(13 citation statements)

References 19 publications

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“…It would be anticipated that myeloablative transplants require more RBC and platelet transfusions than do reduced-intensity or nonablative transplants. 18 In our series, patients who underwent reducedintensity conditioning regimens were less likely to have a nadir of platelet counts to o20 Â 10 9 /L (Po0.001) and were less likely to require platelet transfusions (Po0.0001). However, in those who had a platelet count nadir, the time to engraftment was actually longer than in those who had high-intensity conditioning regimens.…”

Section: Discussionmentioning

confidence: 92%

“…In one study, the median day of platelet recovery was 9, and 50% of cases required no platelet transfusions. 18 In our population, approximately half of those who received low-intensity regimens did have a platelet nadir. These patients usually had a PBSC graft, and interestingly, in those who did nadir, the time to engraftment was actually longer .…”

Section: Discussionmentioning

confidence: 99%

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Clinical factors affecting engraftment and transfusion needs in SCT: a single-center retrospective analysis

Liesveld

Pawlowski

Chen

et al. 2012

Bone Marrow Transplant

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Successful utilization of SCT modalities often requires utilization of both red cell and platelet transfusions. In this retrospective evaluation of clinical factors affecting transplant engraftment and transfusion utilization at a single transplant center in 505 patients from 2005 through 2009, we found that graft type, donor type and the conditioning regimen intensity significantly affected both the neutrophil engraftment time (Po0.001) and the platelet engraftment time (Po0.001). SCT patients required an average of 6.2 red cell units, and 7.9 platelet transfusions in the first 100 days with a wide s.d. Among auto-SCT patients, 5% required neither RBC nor platelet transfusions. Some reduced-intensity transplants were also associated with no transfusion need, and in allogeneic transplants, conditioning regimen intensity was positively correlated with platelet transfusion events as assessed by multivariate analysis. Other patient characteristics such as gender, graft type, donor type, underlying disease and use of TBI were all independently associated with transfusion needs in SCT patients. Further studies are required to understand the means to minimize transfusions and potential related complications in SCT patients.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Clinical factors affecting engraftment and transfusion needs in SCT: a single-center retrospective analysis

Liesveld

Pawlowski

Chen

et al. 2012

Bone Marrow Transplant

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“…MA conditioning was associated with slower recovery compared with RIC. 33,34 The reasons for this finding are uncertain, but could be related to persistent recipient hematopoiesis after RIC that subsequently is displaced by the donor HSC. Additionally, a lower incidence of acute GVHD after RIC compared with MA conditioning could partially explain the observed superior platelet recovery.…”

Section: Discussionmentioning

confidence: 99%

Delayed platelet recovery after allogeneic transplantation: a predictor of increased treatment-related mortality and poorer survival

Ramírez

Brunstein

Miller

et al. 2010

Bone Marrow Transplant

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Delayed platelet recovery (DPR) is common after allo-SCT. Insufficient data on risk factors and association with OS and TRM are available. We conducted a retrospective analysis of all allografts at the University of Minnesota between 2000 and 2005 to characterize the frequency of DPR (platelets o50 000/lL by day 60), risk factors and related complications. A total of 850 patients with hematological malignancies and benign disorders were included. Myeloablative (MA) conditioning was used in 65% of the patients and 45% received umbilical cord blood (UCB) grafts. The 60-day cumulative incidence of platelet recovery was 40% in UCB, 57% in unrelated donor (URD) and 74% in sibling donor. Multivariate analysis confirmed that the variables associated with DPR were MA (versus reduced intensity) conditioning, graft source other than sibling donor, ABO major mismatch, recipient CMV-positive serostatus, the presence of grade II-IV acute GVHD and slower neutrophil recovery. These data demonstrate that DPR is frequent after allogeneic hematopoietic cell transplantation, especially after UCB. DPR is a significant independent risk factor for increased TRM and poorer OS along with HLA-mismatched URD, but not UCB, grade II-IV acute GVHD, old age and advanced disease stage.

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“…Prebet et al reported data on PLT recovery and transfusion needs in 145 adult allogeneic sibling donor HCT recipients with RIC[18]. PLT recovery (>20,000/μl) was seen at a median of 9 days with 68% of the patients demonstrating a PLT count >100,000/μl by day +100.…”

Section: Discussionmentioning

confidence: 99%

Platelet and Red Blood Cell Utilization and Transfusion Independence in Umbilical Cord Blood and Allogeneic Peripheral Blood Hematopoietic Cell Transplants

Solh

Brunstein

Morgan

et al. 2011

Biology of Blood and Marrow Transplantation

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Allogeneic hematopoietic cell transplantation (HCT) recipients have substantial transfusion requirements. Factors associated with increased transfusions and the extent of blood product use in umbilical cord blood (UCB) recipients are uncertain. We reviewed blood product use in 229 consecutive adult recipients of allogeneic HCT at the University of Minnesota: 147 with leukemia, 82 lymphoma or myeloma; 58% received unrelated UCB and 43% sibling donor peripheral blood stem cell (PBSC) grafts. Although neutrophil recovery was prompt (UCB median 17, range 2–45 days, and PBSC 14, range 3–34 days), only 135 of 229 (59% cumulative incidence, CI) achieved RBC independence and 157 (69%) achieved platelet independence by 6 months. Time to platelet independence was prolonged in UCB recipients (median UCB 41 vs. PBSC 14 days) and in patients who had received a prior transplant (median 48 vs. 32 days). Patients who received UCB grafts required more RBC through day 60 post HCT (mean UCB 7.8 (95% CI 6.7–8.9) vs. PBSC 5.2 (3.7–6.7) transfusions, p=0.04), and more platelet transfusions (mean 25.2 (95% CI 22.1–28.2) vs. 12.9 (9.4–16.4), p<0.01) compared to PBSC recipients. Patient receiving myeloablative (MA) conditioning required more RBC and platelet transfusions during the first 2 months post HCT compared to reduced intensity conditioning (RIC) (7.4 vs. 6.2, p=0.3 for RBC; 23.2 vs 17.5, p=0.07 for platelets). Despite prompt neutrophil engraftment, UCB recipients had delayed platelet recovery as well as more prolonged and costly blood product requirements. Enhanced approaches to accelerate multilineage engraftment could limit the transfusion-associated morbidity and costs accompanying UCB allotransplantation.

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Platelet recovery and transfusion needs after reduced intensity conditioning allogeneic peripheral blood stem cell transplantation

Cited by 15 publications

References 19 publications

Clinical factors affecting engraftment and transfusion needs in SCT: a single-center retrospective analysis

Clinical factors affecting engraftment and transfusion needs in SCT: a single-center retrospective analysis

Delayed platelet recovery after allogeneic transplantation: a predictor of increased treatment-related mortality and poorer survival

Platelet and Red Blood Cell Utilization and Transfusion Independence in Umbilical Cord Blood and Allogeneic Peripheral Blood Hematopoietic Cell Transplants

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