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Safety and Cost Effectiveness of a 10 × 109/L Trigger
for Prophylactic Platelet Transfusions Compared With the Traditional 20 × 109/L Trigger: A Prospective Comparative Trial in 105 Patients With Acute Myeloid Leukemia
Hannes Wandt,
Markus Frank,
Gerhard Ehninger,
Christiane Schneider,
Norbert Brack,
Ali Daoud,
Irene Fackler-Schwalbe,
Jürgen Fischer,
Ringfried Gäckle,
Thomas Geer,
Peter Harms,
Birgit Löffler,
Siegfried Öhl,
Burkhard Otremba,
Monika Raab,
Petra Schönrock-Nabulsi,
Gerhard Strobel,
Rolf Winter, and
Hartmut Link
From the 5th Medical Department and
Institute of Medical Oncology and Hematology, Nürnberg, Germany;
the Department of Internal Medicine, Hematology/Oncology, Medical
School Hannover, Hannover, Germany; and the Medical Clinic I, Technical
University Dresden, Dresden, Germany.
In 105 consecutive patients with de novo acute myeloid leukemia
(French-American-British M3 excluded), we compared prospectively the
risk of bleeding complications, the number of platelet and red blood
cell transfusions administered, and the costs of transfusions using two
different prophylactic platelet transfusion protocols. Two hundred
sixteen cycles of induction or consolidation chemotherapy and 3,843 days of thrombocytopenia less than 25 × 109/L were
evaluated. At the start of the study, each of the 17 participating centers decided whether they would use a 10 × 109/L
prophylactic platelet transfusion trigger (group A/8 centers) or a 20 × 109/L trigger (group B/9 centers). Bleeding
complications (World Health Organization grade 2-4) during treatment
cycles were comparable in the two groups: 20 of 110 (18%) in group A
and 18 of 106 (17%) in group B (P = .8). Serious bleeding
events (grade 3-4) were generally not related to the patient's
platelet count but were the consequence of local lesions and plasma
coagulation factor deficiencies due to sepsis. Eighty-six percent of
the serious bleeding episodes occurred during induction chemotherapy.
No patient died of a bleeding complication. There were no significant
differences in the number of red blood cell transfusions administered
between the two groups, but there were significant differences in the number of platelet transfusions administered per treatment cycle: pooled random donor platelet concentrates averaged 15.4 versus 25.4 (P < .01) and apheresis platelets averaged 3.0 versus 4.8 (P < .05) for group A versus group B,
respectively. This resulted in the cost of platelet
therapy being one third lower in group A compared with group B without
any associated increase in bleeding risk.
Blood, Vol. 91 No. 10 (May 15), 1998:
pp. 3601-3606
© 1998 by The American Society of Hematology.
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