Platelet Transfusion Refractoriness in Single-Unit Cord Blood Transplantation for Adults: Risk Factors and Clinical Outcomes

Abstract

Platelet transfusion refractoriness (PTR) is frequently observed after allogeneic hematopoietic cell transplantation (HCT). However, the incidence of and risk factors for PTR, and impact of PTR on transplant outcomes after cord blood transplantation (CBT) have not been fully investigated. We retrospectively analyzed 185 adult patients who received single-unit CBT in our institute. The mean 16-hour corrected count increment (CCI) for the 5840 platelet transfusions was 3.68 × 10/L. Among them, 3196 transfusions (54.7%) were associated with a PTR with 16-hour-CCI <4.5 × 10/L. Results of multivariate analysis indicated that the following factors were significantly associated with decreased platelet transfusion responses: female sex with pregnancy history, male sex, the presence of HLA class I antibody, lower cord blood total nucleated cell dose, lower cord blood CD34 cell dose, 3 locus HLA disparities, body temperature ≥38°C, C-reactive protein ≥10 mg/dL, cytomegalovirus reactivation, use of foscarnet, and use of liposomal amphotericin B. By contrast, graft-versus-host disease prophylaxis including methotrexate, ABO minor mismatch, use of ganciclovir, and use of linezolid were significantly associated with better platelet transfusion responses. PTR had a significant effect on poor neutrophil and platelet recovery, and overall mortality after CBT. These data suggest that early phase PTR may be predictive of engraftment and mortality after single-unit CBT for adults.

Pre-Transplant Platelet Refractoriness and Alternative Donors Are Associated With Cytomegalovirus Retinitis in Hematopoietic Stem Cell Transplantation for Severe Aplastic Anemia

“…Second, disruption of the blood–retinal barrier formed by tight junctions of the retinal blood vessel endothelial cells will accelerate CMV spread to the retina, especially in immunosuppressed transplant recipients ( Duan et al., 1996 ; Zhang et al., 2005 ; Sallam et al., 2018 ; Xu et al., 2018 ). Third, the incidence of platelet refractoriness in patients with bone marrow failure can be as high as 50–70% ( Murphy and Waters, 1990 ), which is an independent poor prognosis factor of transplantation ( Scott et al, 2016 ; Fu et al., 2018 ; Tanoue et al., 2018 ). SAA is a kind of bone marrow failure, and repeated platelet transfusions can easily result in platelet refractoriness.…”

<p>Platelet Transfusion: And Update on Challenges and Outcomes</p>

“…There are only few studies analyzing the incidence of PTR in hematological patients, in patients undergoing hematopoietic stem cell transplantation PTR rate can be as high as near 60% of transfusions. [56][57][58] Etiology of PTR is often multifactorial and can be classified as immune and non-immune causes. Non-immune causes involve near 80% of PTR episodes, being the most frequently reported infection/sepsis, fever, disseminated intravascular coagulation, splenomegaly, graft versus host disease, and antibiotics.…”

Avatrombopag for the salvage treatment of platelet transfusion refractoriness

“… 3 The incidence of PTR is reported to vary from 4.8% to 54.7%. 4 – 6 PTR is also associated with serious adverse events, including severe bleeding, relapse, or deterioration of malignant disease due to reduced, delayed, or discontinued chemotherapy as well as an increased risk of early death. In addition, it may lead to extended hospital stays and increased medical expenses.…”