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Blood, 15 December 2001, Vol. 98, No. 13, pp. 3584-3588
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Decreased transfusion requirements for patients receiving
nonmyeloablative compared with conventional peripheral blood stem cell
transplants from HLA-identical siblings
Florian Weissinger,
Brenda
M. Sandmaier,
David G. Maloney,
William I. Bensinger,
Ted Gooley, and
Rainer Storb
From the Fred Hutchinson Cancer Research Center and the
University of Washington, Seattle.
Red blood cell (RBC) and platelet transfusion requirements in
patients given nonmyeloablative versus conventional peripheral blood stem cell (PBSC) transplants from HLA-matched siblings were compared. Between December 1997 and March 2000, 40 patients, aged 21 to
67 years (median 51), with hematologic malignancies underwent nonmyeloablative allografts after either 2 Gy total body irradiation alone (n = 30) or 2 Gy total body irradiation preceded by fludarabine 30 mg/m2/d on days  4, 3, and 2 (n = 10). All
received postgrafting mycophenolate mofetil and cyclosporine. Controls
included 67 concurrent patients, aged 23 to 66 years (median, 46 years), given conventional PBSC transplants following high-dose
conditioning and postgrafting methotrexate and cyclosporine. Among
patients given nonmyeloablative transplants, 23% required platelet
transfusions compared with 100% among patients given
conventional grafts (P < .0001). Further, the number of
platelet units given to nonmyeloablative recipients was reduced, with a
median of 0 (range, 0 to 214) compared with a median of 24 (range, 4 to
358) after conventional transplantation (P < .0001).
Sixty-three percent of nonmyeloablative recipients required RBC
transfusions compared with 96% of those with conventional grafts
(P = .0001). The number of RBC units transfused was also reduced, with a median of 2 (range, 0 to 50) compared with 6 (range, 0 to 34) after conventional transplantation (P = .0001).
High transfusion requirements before transplantation and
donor-recipient ABO incompatibility increased transfusion requirements
in both patient groups, though neither significantly influenced the
outcome of the analysis. Neither patient age, splenomegaly at
transplantation, development of graft-versus-host disease, nor
posttransplantation cytomegalovirus antigenemia or cytomegalovirus
disease had statistically significant influences on posttransplantation transfusions.
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