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Acute Bleeding After Bone Marrow Transplantation (BMT) Incidence
and Effect on Survival. A Quantitative Analysis in 1,402 Patients
S. Nevo,
V. Swan,
C. Enger,
K.J. Wojno,
R. Bitton,
M. Shabooti,
A.K. Fuller,
R.J. Jones,
H.G. Braine, and
G.B. Vogelsang
From the Johns Hopkins Oncology Center, Baltimore, MD; and the
Department of Pathology, University of Michigan Hospital, Ann Arbor,
MI.
Acute bleeding after bone marrow transplantation (BMT)
was investigated in 1,402 patients receiving transplants at Johns
Hopkins Hospital between January 1, 1986 and June 30, 1995. Bleeding
categorization was based on daily scores of intensity used by the blood
transfusion service. Moderate and severe episodes were analyzed for
bleeding sites. Analysis of the cause of death and the interval of the bleeding episode to outcome endpoints was recorded. Survival estimates were computed for 1,353 BMT patients. The overall incidence was 34%.
Minor bleeding was seen in 10.6%, moderate bleeding was seen in
11.3%, and severe bleeding was seen in 12% of all patients. Fourteen
percent of patients had moderate or severe gastrointestinal hemorrhage,
6.4% had moderate or severe hemorrhagic cystitis, 2.8% had pulmonary
hemorrhage, and 2% had intracranial hemorrhage. Sixty-one percent had
1 bleeding site and 34.4% had more than 1 site. Moderate and severe
bleeding was more prevalent in allogeneic (31%) and unrelated patients
(62.5%) compared with autologous patients (18.5%). Significant
distribution of incidence was found among the different diagnoses, but
not by disease status in acute myeloid leukemia, acute lymphoblastic
leukemia, chronic myelogenous leukemia, Hodgkin's disease, and
non-Hodgkin's lymphoma. Bleeding was associated with
significantly reduced survival in allogeneic, autologous, and unrelated
BMT and in each disease category except multiple myeloma. Survival was
correlated with the bleeding intensity, bleeding site, and the number
of sites. Although close temporal association was evident to mortality,
bleeding was recorded as the cause of death in only the minority of
cases compared with other toxicities after BMT (graft-versus-host
disease, infections, and preparative regimen toxicity). Acute bleeding
is a common complication after BMT that is profoundly associated with
morbidity and mortality. Although bleeding was not a direct cause of
death in the majority of cases, it has a potential prognostic
implication as a predictor of poor outcome in clinical assessment of
patients after BMT.
Blood, Vol. 91 No. 4 (February 15), 1998:
pp. 1469-1477
© 1998 by The American Society of Hematology.
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