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A Risk Model for Thrombocytopenia Requiring Platelet Transfusion
After Cytotoxic Chemotherapy
J.Y. Blay,
A. Le Cesne,
C. Mermet,
C. Maugard,
A. Ravaud,
C. Chevreau,
C. Sebban,
J.-P. Guastalla,
P. Biron, and
I. Ray-Coquard for the ELYPSE1 Study Group
From the Centre L. Bérard, Lyon, France; the Institut Gustave
Roussy, Villejuif, France; Clinique Sainte-Marie,
Chambéry, France; the Centre R. Gauducheau, Nantes, France; the
Fondation Bergonié, Bordeaux, France; and the Centre Cl. Regaud,
Toulouse, France. For the Elypse Study group, see Appendix for
investigator list.
Severe thrombocytopenia is a rare but life-threatening
side effect of cytotoxic chemotherapy for which risk factors are not well known. Our objective was to delineate a risk model for
chemotherapy-induced thrombocytopenia requiring platelet transfusions
in cancer patients. Univariate and multivariate analysis of risk
factors for chemotherapy-induced thrombocytopenia requiring platelet
transfusions were performed on the cohort of the 1,051 patients
(CLB 1996) treated with chemotherapy in the Department
of Medicine of the Centre Léon Bérard (CLB) in 1996. In
univariate analysis, performance status (PS) greater than 1, platelet
count less than 150,000/µL at day 1 (d1) before the initiation of
chemotherapy, d1 lymphocyte count  700/µL, d1 polymorphonuclear
leukocyte count less than 1,500/µL, and the type of chemotherapy
(high risk v others) were significantly associated (P < .01) with an increased risk of severe
thrombocytopenia requiring platelet transfusions. Using logistic
regression, d1 platelet count less than 150,000/µL (odds ratio
[OR], 4.3; 95% confidence interval [CI], 1.9 to 9.6), d1
lymphocyte counts 700/µL (OR, 3.37; 95% CI, 1.77 to 6.4), the
type of chemotherapy (OR, 3.38; 95% CI, 1.77 to 6.4), and PS greater
than 1 (OR, 2.23; 95% CI, 1.22 to 4.1) were identified as independent
risk factors for platelet transfusions. The observed incidences of
platelet transfusions were 45%, 13%, 7%, and 1.5% for patients with
 3, 2, 1, or 0 risk factors, respectively. This model was then tested
in 3 groups of patients treated with chemotherapy used as validation
samples: (1) the series of 340 patients treated in the CLB in the first 6 months of 1997, (2) the prospective multicentric cohort of 321 patients of the ELYPSE 1 study, and (3) the series of 149 patients with
non-Hodgkin's lymphoma treated in the CLB within prospective phase III
trials (1987 to 1995). In these 3 groups, the observed incidences of
platelet transfusions in the above-defined risk groups did not differ
significantly (P > .1) from those calculated in the model.
This risk index could be useful to identify patients at high risk for
chemotherapy-induced thrombocytopenia requiring platelet transfusions.
Blood, Vol. 92 No. 2 (July 15), 1998:
pp. 405-410
© 1998 by the American Society of Hematology.
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