PLATELET TRANSFUSION REQUIREMENTS DURING AUTOLOGOUS PERIPHERAL-BLOOD PROGENITOR-CELL TRANSPLANTATION CORRELATE WITH THE PRETRANSPLANT PLATELET COUNT

The use of primed peripheral blood progenitor cells (PBPC) has improve d platelet engraftment following autologous bone marrow/PBPC transplan tation (ABMT). The thrombocytopenia associated with ABMT generally las ts 14-18 days, and is associated with variable platelet transfusion re quirements. Little, if any, data exist examining prognostic parameters for platelet transfusion requirements during autologous transplantati on. We retrospectively examined 286 consecutive patients undergoing au tologous transplantation from 1 January 1994 to 1 June 1996 with respe ct to platelet engraftment and platelet transfusion requirements. One hundred and fifty four patients were transplanted for breast cancer (5 4%), 72 for non-Hodgkin's lymphoma (25%), 35 for Hodgkin's disease (12 %), 13 for acute leukemia (5%), eight for myeloma (3%), and four for o ther malignancy (1%). The median age was 44. All patients received cyt okine priming, usually with G-CSF, for the procurement of PBPC. The me dian number of CD34(+) cells collected was 4.3 x 10(6)/kg. All patient s received a chemotherapeutic preparative regimen and all received an autologous transplant using PBPC alone. The median time to a platelet count of 20 x 10(9)/l was 13 days. Patients beginning the transplant w ith a less than normal platelet count (less than 150 x 10(9)/l) engraf ted in 17 days, and received a median number of seven platelet transfu sions, as compared with platelet engraftment of 12 days, and four plat elet transfusions, for patients beginning the transplant,vith a normal platelet count (P = 0.001). Both groups of patients received an equiv alent dose of CD34(+) cells. We conclude that thrombocytopenia at the initiation of autologous transplantation is associated with increased platelet transfusion requirements, independent of the dose of CD34(+) cells infused.