Risk Factors and Impact of Secondary Failure of Platelet Recovery After Allogeneic Stem Cell Transplantation.
Secondary failure of platelet recovery (SFPR), a late decrease in the platelet count after primary platelet recovery that is not due to relapse or graft rejection, occasionally occurs after allogeneic hematopoietic stem cell transplantation (HSCT). The risk factors and impact of SFPR on transplantation outcomes are not well known in the clinical setting. Therefore, we retrospectively evaluated 184 adult patients who underwent their first allogeneic HSCT and achieved primary platelet recovery. The cumulative incidence of SFPR, defined as a decrease in the platelet count to below 20,000/µL for more than 7 days, was 12.2% at 3 years, with a median onset of 81 days (range, 39 to 729) after HSCT. Among patients who developed SFPR (n = 23), 19 (82.6%) showed recovery to a sustained platelet count of more than 20,000/µL without transfusion support, and the median duration of SFPR was 23 days (range, 7 to 1048 days). A multivariate analysis showed that in vivo T cell depletion (hazard ratio [HR], 6.92; 95% confidence interval [CI], 2.31 to 20.7; P < .001), grades II to IV acute graft-versus-host disease (HR, 3.99; 95% CI, 1.52 to 10.5; P = .005), and the use of ganciclovir or valganciclovir (HR, 2.86; 95% CI, 1.05 to 7.77; P = .039) were associated with an increased risk for SFPR. The occurrence of SFPR as a time-dependent covariate was significantly associated with inferior overall survival (HR, 2.29; 95% CI, 1.18 to 4.46; P = .015) in a multivariate analysis. These findings may help to improve the management and treatment strategy for SFPR.
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Yu
Y
Akahoshi
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Junya
J
Kanda
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Ayumi
A
Gomyo
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Jin
J
Hayakawa
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Yusuke
Y
Komiya
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Naonori
N
Harada
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Kazuaki
K
Kameda
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Tomotaka
T
Ugai
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Hidenori
H
Wada
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Yuko
Y
Ishihara
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Koji
K
Kawamura
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Kana
K
Sakamoto
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Miki
M
Sato
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Kiriko
K
Terasako-Saito
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Shun-Ichi
SI
Kimura
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Misato
M
Kikuchi
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Hideki
H
Nakasone
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Shinichi
S
Kako
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan. Electronic address: ycanda-tky@umin.ac.jp.
Yoshinobu
Y
Kanda
D000328:Adult; D001792:Blood Platelets / Q000166:cytology* / Q000502:physiology; D005260:Female; D015774:Ganciclovir / Q000009:adverse effects; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D008212:Lymphocyte Depletion / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014184:Transplantation, Homologous / Q000009:adverse effects
D015774:Ganciclovir
Allogeneic hematopoietic stem cell transplantation; Graft-versus-host disease; Platelet; T cell depletion; Thrombocytopenia