RBC and platelet transfusion support in the first 30 and 100 days after haploidentical hematopoietic stem cell transplantation

Abstract

BACKGROUND The volume of haploidentical hematopoietic stem cell transplant (haplo‐HSCT) has increased dramatically in recent years. However, the associated higher risk of delayed engraftment may increase patient transfusion requirements. STUDY DESIGN AND METHODS The post‐HSCT RBC and platelet transfusions of 195 haplo‐HSCT recipients were evaluated. Patient and transplant‐related factors potentially impacting the number of products transfused and time to transfusion independence were assessed. RESULTS Nearly all (98.4%) patients were transfused in the first 30 days, and 59.2% were transfused between days 31 and 100. Among the transfused patients, medians of 5 units (interquartile range [IQR] = 3‐8) of RBCs and 11 units (6‐20) platelets were given in the first 30 days, and medians of 3 units (IQR = 1‐7) of RBCs and 6 units (2‐18) of platelets were transfused between days 31 and 100. Median times for achieving RBC and platelet transfusion independence were 34 (95% CI: 28‐40) and 25 (95% CI: 23‐27) days, respectively. Multivariable analyses showed that RBC transfusions in the 10 days before HSCT were associated with significantly increased and sustained RBC and platelet transfusion requirements. Major ABO incompatibility led to increased RBC transfusions. Advanced disease was associated with increased transfusions during the first 30 days, whereas GVHD increased platelet transfusions between days 31 and 100. Effects of age, sex, CD34+ cell dose, stem cell source, and conditioning regimen were limited or insignificant. CONCLUSIONS This study for the first time provided quantitative transfusion data on a large cohort of haplo‐HSCT recipients and identified factors predictive of increased transfusions.

Increased blood transfusion after outpatient autologous transplantation with reduced intensity conditioning for hematological malignancies predicts worse outcomes

“…Several studies have shown significant associations between increased transfusion support and worse transplant outcomes 10‐12,31 . In the present report, we found that autologous transplant recipients that required more than the median number of PRBC and platelet units had a significantly decreased DFS and OS; consistent with a study assessing haploidentical HSCT recipients which documented that patients with higher than the median PRBC (>5 units), or platelet transfusion requirements (>10 units) during the first 30 days post‐transplantation had lower OS 32 …”

Red blood cell and platelet transfusion support in the first 30 and 100 days after allogeneic hematopoietic cell transplant

“…Consequently, recipients often require more intensive and prolonged transfusion support. [15][16][17] For centers anticipating changes in the distribution of donor and graft types, data on the transfusion needs of HSCT recipients of different donor and graft types can guide their efforts to adjust blood bank inventory and budget appropriately.…”

“…While various studies have shown generally favorable clinical outcomes, both UC and haploidentical transplants are associated with delayed engraftment. Consequently, recipients often require more intensive and prolonged transfusion support 15‐17 . For centers anticipating changes in the distribution of donor and graft types, data on the transfusion needs of HSCT recipients of different donor and graft types can guide their efforts to adjust blood bank inventory and budget appropriately.…”

Optimizing Utilization of Blood Products in the Hematologic Malignancy Clinic: Less Is More

“…Blood product transfusions are frequently used when managing patients with hematologic malignancies (HMs). 1,2 Although this practice may improve symptoms and prevent complications related to anemia and thrombocytopenia, 3 transfusions have the potential to cause a number of adverse effects. [4][5][6] To optimize benefit and minimize risk, multiple studies have assessed the safety of more restrictive transfusion strategies.…”