Acute Bleeding After Bone Marrow Transplantation (BMT)— Incidence and Effect on Survival. A Quantitative Analysis in 1,402 Patients

Abstract

Acute bleeding after bone marrow transplantation (BMT) was investigated in 1,402 patients receiving transplants at Johns Hopkins Hospital between January 1, 1986 and June 30, 1995. Bleeding categorization was based on daily scores of intensity used by the blood transfusion service. Moderate and severe episodes were analyzed for bleeding sites. Analysis of the cause of death and the interval of the bleeding episode to outcome endpoints was recorded. Survival estimates were computed for 1,353 BMT patients. The overall incidence was 34%. Minor bleeding was seen in 10.6%, moderate bleeding was seen in 11.3%, and severe bleeding was seen in 12% of all patients. Fourteen percent of patients had moderate or severe gastrointestinal hemorrhage, 6.4% had moderate or severe hemorrhagic cystitis, 2.8% had pulmonary hemorrhage, and 2% had intracranial hemorrhage. Sixty-one percent had 1 bleeding site and 34.4% had more than 1 site. Moderate and severe bleeding was more prevalent in allogeneic (31%) and unrelated patients (62.5%) compared with autologous patients (18.5%). Significant distribution of incidence was found among the different diagnoses, but not by disease status in acute myeloid leukemia, acute lymphoblastic leukemia, chronic myelogenous leukemia, Hodgkin's disease, and non-Hodgkin's lymphoma. Bleeding was associated with significantly reduced survival in allogeneic, autologous, and unrelated BMT and in each disease category except multiple myeloma. Survival was correlated with the bleeding intensity, bleeding site, and the number of sites. Although close temporal association was evident to mortality, bleeding was recorded as the cause of death in only the minority of cases compared with other toxicities after BMT (graft-versus-host disease, infections, and preparative regimen toxicity). Acute bleeding is a common complication after BMT that is profoundly associated with morbidity and mortality. Although bleeding was not a direct cause of death in the majority of cases, it has a potential prognostic implication as a predictor of poor outcome in clinical assessment of patients after BMT.

Early Onset Noninfectious Pulmonary Syndromes after Hematopoietic Cell Transplantation

“…[79][80][81]84 Respiratory failure requiring mechanical ventilation occurs in most cases, and overall mortality ranges from 64% to 100%. 52,82,85,86 High-dose systemic corticosteroids and supportive care that may include platelet transfusions are standard; procoagulant therapies had variable success in small studies and are not routinely used. 59,60,87,88 Delayed Pulmonary Toxicity Syndrome Delayed pulmonary toxicity syndrome is a subtype of IPS that only occurs after autologous HCT.…”

The clinical impact of platelet refractoriness: correlation with bleeding and survival

“…10,11 The potential role of endothelial damage in relation to increased PLT consumption in nonimmunologic PLT transfusion failure has been suggested by several authors. 3,8,11 In a large study comprising 1402 patients after marrow transplantation, Nevo and colleagues 12 found that bleeding was significantly associated with reduced survival, independent of type of transplantation, stem cell source, and diagnosis. They conclude that the bleeding complications may be regarded as a marker of multifactorial clinical deterioration.…”

An update on platelet transfusion in hematooncology supportive care

“…Although bleeding is not often a direct cause of death in hematopoietic stem cell transplantation, bleeding is associated with significantly reduced survival after HSCT. 32,33 In an interesting analysis using data from their earlier study, Nevo and coworkers 34 found that a cohort of nonbleeding profoundly thrombocytopenic HSCT recipients had an increased early mortality within 100 days after stem cell infusion and reduced overall survival out to 36.5 months. Not surprisingly, the number of profoundly thrombocytopenic patients (four or more PLT counts Յ10 ¥ 10 9 /L) was higher in the study period using the more restrictive transfusion trigger of 10 ¥ 10 9 /L compared to the period using a trigger of 20 ¥ 10 9 /L.…”