Impact of prophylactic platelet transfusions on bleeding events in patients with hematologic malignancies: a subgroup analysis of a randomized trial (CME)

Background A recent randomized trial compared a policy of no prophylaxis with a policy of prophylactic platelet (PLT) transfusions at counts of fewer than 10 × 109/L in patients with hematologic malignancies. The results suggested the effectiveness of prophylactic PLT transfusions may vary according...

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Published in:Transfusion (Philadelphia, Pa.) Pa.), 2014-10, Vol.54 (10), p.2385-2393
Main Authors: Stanworth, Simon J., Estcourt, Lise J., Llewelyn, Charlotte A., Murphy, Michael F., Wood, Erica M.
Format: Article
Language:English
Subjects:
Adult
Aged
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis
Female
Follow-Up Studies
Hematologic Neoplasms - complications
Hematologic Neoplasms - therapy
Hematopoietic Stem Cell Transplantation - adverse effects
Hemorrhage - etiology
Hemorrhage - prevention & control
Humans
Male
Medical sciences
Middle Aged
Platelet Transfusion - methods
Primary Prevention - methods
Transfusions. Complications. Transfusion reactions. Cell and gene therapy
Transplantation, Autologous - adverse effects
Treatment Outcome
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Summary:Background A recent randomized trial compared a policy of no prophylaxis with a policy of prophylactic platelet (PLT) transfusions at counts of fewer than 10 × 109/L in patients with hematologic malignancies. The results suggested the effectiveness of prophylactic PLT transfusions may vary according to patient diagnosis and treatment plan. Study Design and Methods This article presents full subgroup analyses and compares treatment effects between autologous hematopoietic stem cell transplantation (autoHSCT; n = 421) and chemotherapy/allogeneic HSCT (chemo/alloHSCT; n = 179) patients. Results Prespecified subgroup analysis found that the reduction in proportion of patients experiencing WHO Grade 2 to 4 bleeds (main trial outcome) seen in the prophylaxis arm was of greater magnitude in chemo/alloHSCT than autoHSCT patients (interaction p = 0.04). Analysis of secondary outcomes showed a shorter time to first bleeding episode with no prophylaxis in the chemo/alloHSCT group (hazard ratio, 1.84; 95% confidence interval CI, 1.21‐2.79; p = 0.004) compared to the autoHSCT group (hazard ratio, 1.12; 95% CI, 0.85‐1.48; p = 0.4; interaction p = 0.08). The increased number of days with Grade 2 to 4 bleeds with a no‐prophylaxis policy was similar in chemo/alloHSCT (rate ratio, 1.89; 95% CI, 1.10‐3.26) and in autoHSCT patients (rate ratio, 1.43; 95% CI, 1.04‐1.97). Both subgroups showed significant reductions in PLT transfusions with a no‐prophylaxis strategy. Conclusion There is evidence that the effectiveness of prophylactic PLT transfusions may differ between subgroups, with chemo/alloHSCT patients receiving prophylactic PLT transfusions appearing to show a greater reduction in bleeding outcomes compared to patients following a no‐prophylaxis policy.
ISSN:0041-1132
1537-2995
DOI:10.1111/trf.12646