Prognostic significance of platelet recovery pattern after allogeneic HLA-identical sibling transplantation and its association with severe acute GVHD.
Thrombocytopenia (TP) is a frequent complication after allogeneic stem cell transplantation (SCT) and regarded as a poor prognostic factor when assessed beyond day 100. However, little is known about the clinical significance of the platelet recovery pattern before chronic graft-versus-host disease (GVHD) develops. Eighty-five patients undergoing HLA-identical sibling SCT were stratified according to their platelet recovery pattern between day +30 and +90 and the transplant outcomes analyzed, along with the association of each component of the acute GVHD grading system. Fifteen patients (18%) were classified with persistent TP, 33 patients (39%) with unstable TP, and 37 patients (43%) as non-TP. Persistent TP, which was strongly associated with severe acute GVHD (P<0.001), exhibited the worst 2-year OS (P<0.0001) and highest NRM (P<0.0001) and opportunistic infection rates (P<0.0001). In multivariate analyses, the platelet recovery pattern was identified as an independent prognostic factor (P=0.02) together with the disease risk (P=0.02) in terms of OS, and the only independent prognostic factor in terms of NRM (P=0.005) and the incidence of infectious events (P<0.001). Persistent TP was strongly associated with the development of extensive chronic GVHD (P=0.03). The platelet recovery pattern between day +30 and +90 can be used to predict the prognosis of SCT recipients.
Kim
D H
DH
Department of Hematology/Oncology, Kyungpook National University Hospital, Daegu, Korea.
Sohn
S K
SK
Jeon
S B
SB
Baek
J H
JH
Kim
J G
JG
Lee
N Y
NY
Suh
J S
JS
Lee
K B
KB
Shin
I H
IH
D000293:Adolescent; D000328:Adult; D001792:Blood Platelets; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D006650:Histocompatibility Testing; D006801:Humans; D019520:Living Donors; D008232:Lymphoproliferative Disorders / Q000150:complications / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000209:etiology / Q000401:mortality; D011379:Prognosis; D020127:Recovery of Function; D035781:Siblings; D033581:Stem Cell Transplantation; D013921:Thrombocytopenia / Q000209:etiology / Q000401:mortality*; D014184:Transplantation, Homologous