Impact of platelet transfusion on toxicity and mortality after hematopoietic progenitor cell transplantation

Christou, Grace; Kekre, Natasha; Petrcich, William; Tokessy, Melanie; Neurath, Doris; Giulivi, Antonio; Saidenberg, Elianna; McDiarmid, Sheryl; Atkins, Harold L.; Bence‐Bruckler, Isabelle; Bredeson, Christopher; Huebsch, Lothar; Sabloff, Mitchell; Sheppard, Dawn; Tay, Jason; Tinmouth, Alan; Allan, David S.

doi:10.1111/trf.12817

Cited by 17 publications

(11 citation statements)

References 15 publications

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“…3,6,13 In previous reports, PTR in HSCT was associated with increased 100-day non-relapse mortality, post-transplant length of hospital stay, the need for intensive care unit admission, and the number of organs affected by severe toxicity. 8 Especially in the case of HSCT, a low platelet count may lead to fatal outcomes and immediate treatment for PTR is required. Once a patient is alloimmunized, both HLA-matched PLTs and cross-matched PLTs improve platelet count increments.…”

Section: Discussionmentioning

confidence: 99%

“…Inadequate post‐transfusion platelet increment occurs in over 50% of PLTs in patients undergoing HSCT. PTR after HSCT is also associated with early non‐relapse mortality and the effect of PLT is critical for prognosis . When HSCT recipients with HLA antibody have post PTR, we order cross‐matched PLT units consistent with HLA Class I and also confirmed by physical lymphocyte cross‐matching.…”

mentioning

confidence: 99%

“…PTR after HSCT is also associated with early non-relapse mortality and the effect of PLT is critical for prognosis. 8,9 When HSCT recipients with HLA antibody have post PTR, we order crossmatched PLT units consistent with HLA Class I and also confirmed by physical lymphocyte cross-matching. It is difficult, especially after HSCT, to predict the extent of thrombocytopenia; therefore, it is often necessary to order PLT units on the day of PLT transfusion.…”

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confidence: 99%

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

et al. 2020

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BACKGROUND Cross‐matched platelet (cross‐matched PLT) transfusion is effective for immune‐mediated platelet transfusion refractoriness (PTR), but is more costly and time‐consuming for physical cross‐match than using standard PLT units. Recent studies have reported the utility of human leucocyte antigens (HLA) virtual cross‐matched PLT (HLA‐matched PLT) that is defined as HLA‐A/B matched or no antibody against donor‐specific antigen. Here, we evaluated the effect of HLA‐matched PLTs for PTR in post hematopoietic stem cell transplant (HSCT) recipients. STUDY DESIGN AND METHODS Our study included a total of 241 PLTs in 16 patients who underwent HSCT at Okayama University Hospital between 2010 and 2017, receiving either HLA‐matched or cross‐matched PLTs. We calculated the 24‐hour corrected count increments (CCI‐24) to evaluate the effect of PLTs. A CCI‐24 ≥ 4500 was considered to be a successful transfusion. RESULTS We analyzed 139 cross‐matched PLTs and 102 HLA‐matched PLTs. In the immune‐mediated PTR, the rate of successful transfusion was 60.5% for cross‐matched PLT and 63.4% for HLA‐matched PLT (p = 0.825). On the other hand, the median CCI‐24 for cross‐matched PLT transfusions and HLA‐matched PLT transfusions were 1856 and 5824 (p < 0.001), with a success rate of 28.1 and 54.1% in cases with non‐immune‐mediated PTR, respectively (p = 0.001). CONCLUSION The effectiveness of HLA‐matched PLT is not inferior to cross‐matched PLT. This result indicates that physical cross‐match can be omitted in post HSCT PTR.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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

et al. 2020

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“…In a study of patients with acute leukaemia, increased platelet transfusions during induction was associated with decreased survival 29 and we have recently demonstrated an association between transplant-related morbidity and mortality with the number of platelet transfusions. 5 Therapeutic versus prophylactic platelet transfusion strategies in patients undergoing autologous haematopoietic stem cell transplantation As described above, the results of two recent randomised controlled trials lead us to question the value of prophylactic platelet transfusions in patients undergoing ASCT. Additional evidence for the efficacy of a therapeutic platelet transfusion strategy in this patient group was reported by Wandt et al 7 They instituted a therapeutic platelet transfusion strategy in consecutive, clinically stable patients undergoing ASCT.…”

Section: Platelet Transfusion Requirements In Autologous Stem Cell Trmentioning

confidence: 99%

“…5 However, the true benefit of prophylactic platelet transfusions in the ASCT setting is unclear and has been called into question by several recent studies. [6][7][8] Prophylactic platelet transfusions may not only be unnecessary, they may be detrimental to the patient.…”

Section: Introduction Background and Rationalementioning

confidence: 99%

Rationale and design of platelet transfusions in haematopoietic stem cell transplantation: the PATH pilot study

et al. 2016

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IntroductionIn patients with transient thrombocytopenia being treated with high-dose chemotherapy followed by stem cell rescue—haematopoietic stem cell transplantation (HSCT), prophylactic transfusions are standard therapy to prevent bleeding. However, a recent multicentre trial suggests that prophylactic platelet transfusions in HSCT may not be necessary. Additionally, the potential overuse of platelet products places a burden on a scarce healthcare resource. Moreover, the benefit of prophylactic platelet transfusions to prevent clinically relevant haemorrhage is debatable. Current randomised data compare different thresholds for administering prophylactic platelets or prophylactic versus therapeutic platelet transfusions. An alternative strategy involves prescribing prophylactic antifibrinolytic agents such as tranexamic acid to prevent bleeding.Methods and analysisThis report describes the design of an open-labelled randomised pilot study comparing the prophylactic use of oral tranexamic acid with platelet transfusions in the setting of autologous HSCT. In 3–5 centres, 100 patients undergoing autologous HSCT will be randomly assigned to either a prophylactic tranexamic acid or prophylactic platelets bleeding prevention strategy-based daily platelet values up to 30 days post-transplant. The study will be stratified by centre and type of transplant. The primary goal is to demonstrate study feasibility while collecting clinical outcomes on (1) WHO and Bleeding Severity Measurement Scale (BSMS), (2) transplant-related mortality, (3) quality of life, (4) length of hospital stay, (5) intensive care unit admission rates, (6) Bearman toxicity scores, (7) incidence of infections, (8) transfusion requirements, (9) adverse reactions and (10) economic analyses.Ethics and disseminationThis study is funded by a peer-reviewed grant from the Canadian Institutes of Health Research (201 503) and is registered on Clinicaltrials.gov NCT02650791. It has been approved by the Ottawa Health Science Network Research Ethics Board. Study results will presented at national and international conferences. Importantly, the results of this trial will inform the feasibility and conduct of a larger study.Trial registration numberNCT02650791; Pre-results.

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

et al. 2017

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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.

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Impact of platelet transfusion on toxicity and mortality after hematopoietic progenitor cell transplantation

Abstract: HPCT-related toxicity and mortality are associated with increased PLT transfusion events. Alternative strategies to reduce PLT transfusions after HPCT may warrant future study.

Cited by 17 publications

References 15 publications

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

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

Rationale and design of platelet transfusions in haematopoietic stem cell transplantation: the PATH pilot study

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

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