Factors influencing platelet transfusion refractoriness in patients undergoing allogeneic hematopoietic stem cell transplantation

Abstract

Hematopoietic stem cell transplantation has been considered a risk factor for development of platelet transfusion refractoriness. The objective of this study was to assess the platelet transfusion refractoriness rate in patients undergoing allogeneic hematopoietic stem cell transplantation from different sources. We retrospectively reviewed the charts and transfusion records of patients who underwent allogeneic stem cell transplantation at our institution between 2013 and 2015. The evaluation of post-transfusion platelet count was assessed for each transfusion given, from day of progenitor infusion to day 30 after transplantation. Of 167 patients included in this study, 101 received peripheral blood stem cell transplantation (PBSCT) and 66 received umbilical cord blood transplantation (UCBT). Overall, the percentage of platelet transfusions with a 14-h CCI lower than 5000 was 59.3%, being these data significantly higher for UCBT (67.6%) than for PBSCT (31.0%). Seventy-eight percent of patients underwent UCBT become refractory, while 38.6% of patients who received PBSCT were refractory. Factors associated to platelet refractoriness were lower CD34+ cell dose infused, higher number of antibiotics used, presence of anti-HLA I antibodies, and reduced-intensity conditioning regimen. Platelet refractoriness is a frequent and complex adverse event and remains a therapeutic challenge in the management of patients undergoing HSCT. There is a higher rate of platelet refractoriness in patients who received UCBT as compared to patients who received PBSCT.

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

“…Of the total 5840 platelet transfusions given to 185 adults, 3196 transfusions (54.7%) with 16-hour CCI <4.5 × 10 9 /L were associated with a poor transfusion response, indicating that PTR was a relatively common problem in adult patients undergoing CBT. This is consistent with a previous report [10]. Risk factors for PTR included the following: presence of HLA class I antibody, lower CB TNC dose, lower CB CD34 + cell dose, 3 locus HLA disparities, body temperature ≥38°C, CRP ≥10 mg/dL, CMV reactivation, use of foscarnet, and use of liposomal amphotericin B.…”

“…However, some patients do not achieve the expected platelet count increment after platelet transfusion. Several studies have demonstrated that platelet transfusion refractoriness (PTR) is common after allogeneic HCT [3][4][5][6][7][8][9][10][11][12][13].…”

“…Therefore, PTR tends to be problematic, especially in adult patients undergoing CBT. Although risk factors and survival impact of PTR in pediatric [3,4] and adult [5][6][7][8][9][10] patients undergoing allogeneic HCT from other graft sources have been extensively analyzed, the effects of PTR on the outcomes after CBT are limited [10]. In the present study, we retrospectively evaluated (1) risk factors for PTR and (2) the impact of PTR during early and mid-phase CBT on engraftment and survival after single-unit CBT.…”

A pilot trial of complement inhibition using eculizumab to overcome platelet transfusion refractoriness in human leukocyte antigen allo‐immunized patients

“…Although we could not consider him to have had a response per protocol, there was some evidence suggesting a clinical benefit as he also met the 10–60 min CCI > 7 500 and 18–24 h CCI > 5 000 after the third and fourth transfusion of platelets given after eculizumab treatment (Table SII). Since only 10 patients were treated in our trial, the study was not powered to estimate the response rate precisely and is unable to identify unique patient characteristics leading to refractoriness and factors predicting response to eculizumab (Slichter et al , ; Solves et al , ). Nevertheless, the resolution of platelet refractoriness in a subset of responding patients treated with eculizumab provides proof of concept and data supporting complement as playing a pathophysiologic role in platelet refractoriness.…”

Efficacy of HLA virtual cross‐matched platelet transfusions for platelet transfusion refractoriness in hematopoietic stem cell transplantation

“…A difference has been reported in CCI depending on the type of stem cell source. There was a higher rate of PTR in patients who received umbilical cord blood transplantation (UCBT) as compared to patients who received peripheral blood stem cell transplantation (PBSCT) . Here, we could not assess the effect of stem cell source because the number of patients given cells from each stem cell source was limited, and the variance of CCI‐24 between each patient was large.…”