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Isolated thrombocytopenia after allogeneic bone marrow transplantation:
existence of transient and chronic thrombocytopenic syndromes
LR First, BR Smith, J Lipton, DG Nathan, R Parkman and JM Rappeport
Isolated thrombocytopenia after bone marrow transplantation was
investigated in 65 fully engrafted patients surviving at least 60 days
posttransplant. Twenty-four patients (37%) developed this complication,
which occurred most frequently in patients receiving pretransplant
preparation with total body irradiation or busulfan. Two distinct
thrombocytopenic syndromes were identified: (1) transient thrombocytopenia
(nine patients), in which a normal platelet count (greater than
100,000/microL) was initially established by day +40 but then diminished to
less than 10,000 to 45,000/microL on day +40 to +70, with subsequent
resolution of the thrombocytopenia by day +90; (2) chronic thrombocytopenia
(15 patients), in which a platelet count greater than 100,000/microL was
not achieved at any time during the first four months posttransplant,
despite the simultaneous presence of normal granulocyte and reticulocyte
counts. Although the transient syndrome did not adversely affect prognosis,
the chronic syndrome carried a high mortality (21% actuarial survival at
1,000 days posttransplant compared with 67% survival for all patients, P
less than .01) and had a high association with both severe (grades 3 to 4)
acute graft-versus-host disease (GVHD) and chronic GVHD. In three of nine
patients with transient thrombocytopenia, a temporal association with
trimethoprim-sulfamethoxazole administration was observed, whereas in all
other patients, no drug association could be found. Bone marrow biopsies in
those patients with drug-associated thrombocytopenia showed decreased
numbers of megakaryocytes, whereas biopsies in the remainder of the
transiently thrombocytopenic patients demonstrated adequate numbers of
platelet precursors, suggesting peripheral platelet destruction or
ineffective thrombopoiesis. Biopsies in the chronic thrombocytopenic
patients included those with and without adequate numbers of platelet
precursors, although the association with chronic GVHD was strongest in
patients demonstrating normal numbers of megakaryocytes. We conclude that
isolated thrombocytopenia represents a significant complication of bone
marrow transplantation, particularly in patients receiving hematopoietic
ablative preparatory regimens, and that it is the chronic, not the
transient, thrombocytopenic syndrome that is associated with an adverse
patient prognosis.
Volume 65,
Issue 2,
pp. 368-374,
02/01/1985
Copyright © 1985 by The American Society of Hematology
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