RANDOMIZED STUDY OF PROPHYLACTIC PLATELET TRANSFUSION THRESHOLD DURING INDUCTION THERAPY FOR ADULT ACUTE-LEUKEMIA - 10,000 MU-L VERSUS 20,000/MU-L/

Purpose: We designed and conducted a randomised single-institution tri al comparing two common prophylactic platelet transfusion thresholds i n patients undergoing induction therapy for acute leukemia. Patients a nd Methods: Seventy-eight patients undergoing induction therapy for ac ute leukemia were randomized to receive prophylactic apheresis platele t concentrates when the platelet count was either less than or equal t o 10,000/mu l or less than or equal to 20,000/mu L. Results: There was no significant difference in the total number of bleeding episodes pe r patient with a median of four in the less than or equal to 10,000/mu L arm and two in the less than or equal to 20,000/mu L arm (25th to 7 5th percentiles of 2, 7 and 1, 5, respectively; P = .12). Patients ran domized to the less than or equal to 10,000/mu L arm received more pla telet transfusions for bleeding [one (0, 2) v zero (0, 0); P = .0003]. In contrast, patients on the less than or equal to 20,000/mu L arm re ceived more platelet transfusions for prophylactic indications [10 (5, 14) v six (3, 8); P = 0.001], as would be expected, but less for blee ding. Nevertheless, the total number of platelet transfusions given to patients on the less than or equal to 20,000/mu L arm was higher and nearly significant [11 (6, 15) v seven (5, 11); P =.07]. There were no statistically significant differences between the groups with regard to RBC transfusion requirements, febrile days, days hospitalized, days thrombocytopenic, need for HLA-matched platelets, remission rate, or death during induction chemotherapy. No patient in either group died f rom hemorrhage or underwent major surgery for bleeding complications. Conclusion: Giving prophylactic platelets at a threshold of less than or equal to 10,000/mu L compared with less than or equal to 20,000/mu L can decrease the total utilization of platelets with only ct small a dverse effect on bleeding, and no statistically significant effect on morbidity. (C) 1997 by American Society of Clinical Oncology.