Platelet and Red Blood Cell Utilization and Transfusion Independence in Umbilical Cord Blood and Allogeneic Peripheral Blood Hematopoietic Cell Transplants

Abstract

Allogeneic hematopoietic cell transplantation (HCT) recipients have substantial transfusion requirements. Factors associated with increased transfusions and the extent of blood product use in umbilical cord blood (UCB) recipients are uncertain. We reviewed blood product use in 229 consecutive adult recipients of allogeneic HCT at the University of Minnesota: 147 with leukemia, 82 lymphoma or myeloma; 58% received unrelated UCB and 43% sibling donor peripheral blood stem cell (PBSC) grafts. Although neutrophil recovery was prompt (UCB median 17, range 2–45 days, and PBSC 14, range 3–34 days), only 135 of 229 (59% cumulative incidence, CI) achieved RBC independence and 157 (69%) achieved platelet independence by 6 months. Time to platelet independence was prolonged in UCB recipients (median UCB 41 vs. PBSC 14 days) and in patients who had received a prior transplant (median 48 vs. 32 days). Patients who received UCB grafts required more RBC through day 60 post HCT (mean UCB 7.8 (95% CI 6.7–8.9) vs. PBSC 5.2 (3.7–6.7) transfusions, p=0.04), and more platelet transfusions (mean 25.2 (95% CI 22.1–28.2) vs. 12.9 (9.4–16.4), p<0.01) compared to PBSC recipients. Patient receiving myeloablative (MA) conditioning required more RBC and platelet transfusions during the first 2 months post HCT compared to reduced intensity conditioning (RIC) (7.4 vs. 6.2, p=0.3 for RBC; 23.2 vs 17.5, p=0.07 for platelets). Despite prompt neutrophil engraftment, UCB recipients had delayed platelet recovery as well as more prolonged and costly blood product requirements. Enhanced approaches to accelerate multilineage engraftment could limit the transfusion-associated morbidity and costs accompanying UCB allotransplantation.

Clinical factors affecting engraftment and transfusion needs in SCT: a single-center retrospective analysis

“…We restricted our analysis to first transplants because second transplants have of themselves been associated with increased frequency and duration of transfusion need. 7 Our data showed that time to platelet engraftment was significantly influenced by graft type, donor type and intensity of conditioning regimes. That time to platelet engraftment was influenced by graft type and donor type has been previously reported, with PBSC grafts associated with faster platelet engraftment.…”

“…Time to platelet independence in one large series of cord blood transplants was 41 versus 14 days for PBSC grafts in other allogeneic transplants and 25 vs 13 days for red cell transfusion independence. 7 In this series, cord blood transplant recipients also required more RBC and platelet transfusions than did recipients of other graft types.…”

“…In spite of advantages of umbilical cord blood in shortened stem cell procurement times and decreased GVHD incidence and severity, 6 most evidence indicates delayed platelet engraftment times and, in some cases, delayed time to neutrophil engraftment. 7 The significance of delayed neutrophil and platelet engraftment times on overall survival has been reported, 8 but the extent to which engraftment times are affected by demographic, therapeutic and other clinical factors is poorly understood. In this retrospective study of consecutive patients undergoing SCT at the University of Rochester, we assessed the relationship between platelet and neutrophil engraftment times and patient age, gender, donor source of stem cells, type of graft and the effect of conditioning regimen intensity.…”

Transfusion Support Issues in Hematopoietic Stem Cell Transplantation

“…3 In general, engraftment time is shortest with HPC-A and greatest when HPC-C is used 6 ; however, considerable patient-to-patient variability exists. One study that compared HPC-C and HPC-A noted roughly equivalent neutrophil recovery times but found a longer time to platelet and RBC engraftment for HPC-C. 5 These prolonged engraftment times translated into higher transfusion rates for RBCs and platelets.…”

“…3 RBC engraftment is more difficult to assess and may be defined by the appearance of 1% reticulocytes in the peripheral blood, 4 or, on the day of the last RBC transfusion, with no transfusion given the following 30 days. 5 Typically, neutrophil engraftment is defined as an absolute neutrophil count of more than 500/µL across 3 consecutive days. 3 Engraftment is influenced by many factors, including the relationship of the donor to the patient, the stem cell source, and the dose of CD34 + cells in the transplantation.…”