title: A multicenter study of platelet recovery and utilization in patients after myeloablative therapy and hematopoietic stem cell transplantation.
abstract: 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.
authors.affiliation: Epidemiology of Platelet Recovery Study Group and Genentech, South San Francisco, CA, USA.
authors.forename: S H
authors.initials: SH
authors.lastname: Bernstein
authors.forename: A P
authors.initials: AP
authors.lastname: Nademanee
authors.forename: J M
authors.initials: JM
authors.lastname: Vose
authors.forename: G
authors.initials: G
authors.lastname: Tricot
authors.forename: J W
authors.initials: JW
authors.lastname: Fay
authors.forename: R S
authors.initials: RS
authors.lastname: Negrin
authors.forename: J
authors.initials: J
authors.lastname: DiPersio
authors.forename: G
authors.initials: G
authors.lastname: Rondon
authors.forename: R
authors.initials: R
authors.lastname: Champlin
authors.forename: M J
authors.initials: MJ
authors.lastname: Barnett
authors.forename: K
authors.initials: K
authors.lastname: Cornetta
authors.forename: G P
authors.initials: GP
authors.lastname: Herzig
authors.forename: W
authors.initials: W
authors.lastname: Vaughan
authors.forename: G
authors.initials: G
authors.lastname: Geils
authors.forename: A
authors.initials: A
authors.lastname: Keating
authors.forename: H
authors.initials: H
authors.lastname: Messner
authors.forename: S N
authors.initials: SN
authors.lastname: Wolff
authors.forename: K B
authors.initials: KB
authors.lastname: Miller
authors.forename: C
authors.initials: C
authors.lastname: Linker
authors.forename: M
authors.initials: M
authors.lastname: Cairo
authors.forename: S
authors.initials: S
authors.lastname: Hellmann
authors.forename: M
authors.initials: M
authors.lastname: Ashby
authors.forename: S
authors.initials: S
authors.lastname: Stryker
authors.forename: R A
authors.initials: RA
authors.lastname: Nash
mesh_terms: D018952:Antigens, CD34 / Q000032:analysis; D001792:Blood Platelets / Q000166:cytology*; D016026:Bone Marrow Transplantation / Q000379:methods*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010976:Platelet Count; D017713:Platelet Transfusion; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D018952:Antigens, CD34