Profound thrombocytopenia and survival of hematopoietic stem cell transplant patients without clinically significant bleeding, using prophylactic platelet transfusion triggers of 10 × 109 or 20 × 109 per L.

BACKGROUND: A trigger of 10 × 109 per L for prophylactic platelet (PLT) transfusions is generally recommended for stable thrombocytopenic patients who receive chemotherapy, based on studies showing similar incidence, severity, and fatality of bleeding compared with the 20 × 109 per L trigger. The outcome of thrombocytopenic nonbleeding patients has not been well described. This retrospective analysis evaluates thrombocytopenia and survival of 381 hematopoietic stem cell transplant (HSCT) patients without clinically significant bleeding, with 10 × 109 and 20 × 109 per L prophylactic triggers. STUDY DESIGN AND METHODS: A total of 170 patients who received prophylactic PLT transfusions at 20 × 109 per L (1997-1998, SP1) and 211 patients who had prophylaxis at 10 × 109 per L (1999-2001, SP2) were identified as nonbleeding patients. PLT counts and clinical complications were assessed within 100 days from HSCT. RESULTS: PLT counts less than or equal to 10 × 109 per L were found in 69.2 percent of patients in SP2 and 38.3 percent in SP1 (p < 0.001). Profound thrombocytopenia (4+ PLT counts ≤10 × 109/L) was found in 19.0 percent of patients in SP2 and 7.0 percent in SP1 (p = 0.001). Patients with profound thrombocytopenia had significantly increased early mortality (odds ratio [OR], 3.18; 95% confidence interval [CI], 1.25-8.07) and significantly reduced overall survival (hazard ratio [HR], 1.95; 95% CI, 1.28-2.97) compared to patients with 0 to 3 PLT counts less than or equal to 10 × 109 per L. The association of profound thrombocytopenia with early mortality was more notable in SP2. CONCLUSION: The 10 × 109 per L transfusion trigger is associated with significantly greater exposure to low PLT counts. Nonbleeding patients with profound thrombocytopenia were at significantly greater risk of dying compared with nonthrombocytopenic patients. These results suggest that safety of the 10 × 109 per L trigger should be more thoroughly evaluated. [ABSTRACT FROM AUTHOR]