ACUTE BLEEDING AFTER BONE-MARROW TRANSPLANTATION (BMT) - INCIDENCE AND EFFECT ON SURVIVAL - A QUANTITATIVE-ANALYSIS IN 1,402 PATIENTS

Acute bleeding after bone marrow transplantation (BMT) was investigate d in 1,402 patients receiving transplants at Johns Hopkins Hospital be tween January 1, 1986 and June 30, 1995. Bleeding categorization was b ased on daily scores of intensity used by the blood transfusion servic e. Moderate and severe episodes were analyzed for bleeding sites. Anal ysis of the cause of death and the interval of the bleeding episode to outcome endpoints was recorded. Survival estimates were computed for 1,353 BMT patients. The overall incidence was 34%. Minor bleeding was seen in 10.6%, moderate bleeding was seen in 11.3%, and severe bleedin g was seen in 12% of all patients. Fourteen percent of patients had mo derate or severe gastrointestinal hemorrhage, 6.4% had moderate or sev ere hemorrhagic cystitis, 2.8% had pulmonary hemorrhage, and 2% had in tracranial hemorrhage. Sixty-one percent had 1 bleeding site and 34.4% had more than 1 site. Moderate and severe bleeding was more prevalent in allogeneic (31%) and unrelated patients (62.5%) compared with auto logous patients (18.5%). Significant distribution of incidence was fou nd among the different diagnoses, but not by disease status in acute m yeloid leukemia, acute lymphoblastic leukemia, chronic myelogenous leu kemia, Hodgkin's disease,and non-Hodgkin's lymphoma. Bleeding was asso ciated with significantly reduced survival in allogeneic, autologous, and unrelated BMT and in each disease category except multiple myeloma . Survival was correlated with the bleeding intensity, bleeding site, and the number of sites. Although close temporal association was evide nt to mortality, bleeding was recorded as the cause of death in only t he minority of cases compared with other toxicities after BMT (graft-v ersus-host disease, infections, and preparative regimen toxicity). Acu te bleeding is a common complication after BMT that is profoundly asso ciated with morbidity and mortality. Although bleeding was not a direc t cause of death in the majority of cases, it has a potential prognost ic implication as a predictor of poor outcome in clinical assessment o f patients after BMT. (C) 1998 by The American Society of Hematology.