Platelet recovery and transfusion needs after reduced intensity conditioning allogeneic peripheral blood stem cell transplantation

Objective

The aim of this retrospective study was to assess platelet transfusion needs and the kinetics and predictive factors for platelet recovery after reduced-intensity conditioning (RIC) allogeneic hematopoietic stem cell transplantation (HSCT).

Materials and Methods

The profile of platelet recovery and transfusion needs in the first 100 days after RIC allo-SCT from a human leukocyte antigen–identical sibling donor was analyzed in a single-center series of 166 consecutive patients.

Results

Platelet recovery (>20g/L) was observed at a median of 9 days (range, 0–99 days) after allo-SCT. One-hundred forty-five patients could be assessed for platelet recovery at day +100, of which 99 (68%) had a platelet count >99g/L. In the multivariate analysis, a lower platelet counts before the start of conditioning, and occurrence of grade III to IV acute graft-vs-host disease significantly influenced day-100 platelet recovery >100 × 10⁹/L (odds ratio [OR] = 2.51; 95% confidence interval [CI], 1.13–5.61; p = 0.025; and OR = 7.6; 95% CI, 3.0–19.29; p = 0.00002, respectively). Eighty-three patients (50%) did not require any platelet transfusion during follow-up. Multivariate analysis found the following parameters to be significantly associated with platelet transfusion needs: conditioning regimen type (use of antithymoglobulin: OR = 3.96; 95% CI, 1.77–8.89; p = 0.008), platelet count prior to RIC administration (>144g/L; OR = 0.18; 95% CI, 0.08–0.39; p = 0.00001) and occurrence of grade III to IV acute GVHD (OR = 11.62; 95% CI, 4.01–33.66; p = 0.000006).

Conclusions

Overall, these observations show a lower rate of platelet transfusion and faster platelet recovery kinetics after RIC HSCT, but also highlight the negative effect of severe acute GVHD as a risk factor for increased need for platelet transfusions.