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A Multicenter Study of Platelet Recovery and Utilization in
Patients After Myeloablative Therapy and Hematopoietic Stem Cell
Transplantation
Steven H. Bernstein,
Auayporn P. Nademanee,
Julie M. Vose,
Guido Tricot,
Joseph W. Fay,
Robert S. Negrin,
John DiPersio,
Gabriela Rondon,
Richard Champlin,
Michael J. Barnett,
Kenneth Cornetta,
Geoffrey P. Herzig,
William Vaughan,
George Geils Jr,
Armand Keating,
Hans Messner,
Steven N. Wolff,
Kenneth B. Miller,
Charles Linker,
Mitchell Cairo,
Susan Hellmann,
Mark Ashby,
Scott Stryker, and
Richard
A. Nash
From the Epidemiology of Platelet Recovery Study Group and Genentech,
South San Francisco, CA.
An observational study was conducted at 18 transplant centers in the
United States and Canada to characterize the platelet recovery of
patients receiving myeloablative therapy and stem cell transplantation
and to determine the clinical variables influencing recovery, determine
platelet utilization and cost, and incidence of hemorrhagic events. The
study included 789 evaluable patients transplanted in 1995. Clinical,
laboratory, and outcome data were obtained from the medical records.
Variables associated with accelerated recovery in multivariate models
included (1) higher CD34 count; (2) higher platelet count at the start
of myeloablative therapy; (3) graft from an HLA-identical sibling
donor; and (4) prior stem cell transplant. Variables associated with
delayed recovery were (1) prior radiation therapy; (2) posttransplant
fever; (3) hepatic veno-occlusive disease; and (4) use of
posttransplant growth factors. Disease type also influenced recovery.
Recipients of peripheral blood stem cells (PBSC) had faster recovery
and fewer platelet transfusion days than recipients of bone marrow
(BM). The estimated average 60-day platelet transfusion cost per
patient was $4,000 for autologous PBSC and $11,000 for allogeneic BM
transplants. It was found that 11% of all patients had a significant
hemorrhagic event during the first 60 days posttransplant, contributing
to death in 2% of patients. In conclusion, clinical variables
influencing platelet recovery should be considered in the design and
interpretation of clinical strategies to accelerate recovery. Enhancing
platelet recovery is not likely to have a significant impact on 60-day mortality but could significantly decrease health care costs and potentially improve patient quality of life.
Blood, Vol. 91 No. 9 (May 1), 1998:
pp. 3509-3517
© 1998 by The American Society of Hematology.
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