A MULTICENTER STUDY OF PLATELET RECOVERY AND UTILIZATION IN PATIENTS AFTER MYELOABLATIVE THERAPY AND HEMATOPOIETIC STEM-CELL TRANSPLANTATION

An observational study was conducted at 18 transplant centers in the U nited States and Canada to characterize the platelet recovery of patie nts receiving myeloablative therapy and stem cell transplantation and to determine the clinical variables influencing recovery, determine pl atelet utilization and cost, and incidence of hemorrhagic events. The study included 789 evaluable patients transplanted in 1995. Clinical, laboratory, and outcome data were obtained from the medical records. V ariables associated with accelerated recovery in multivariate models i ncluded (1) higher CD34 count; (2) higher platelet count at the start of myeloablative therapy; (3) graft from an HLA-identical sibling dono r; and (4) prior stem cell transplant. Variables associated with delay ed recovery were (1) prior radiation therapy: (2) posttransplant fever ; (3) hepatic veno-occlusive disease; and (4) use of posttransplant gr owth factors. Disease type also influenced recovery. Recipients of per ipheral blood stem cells (PBSC) had faster recovery and fewer platelet transfusion days than recipients of bone marrow (BM). The estimated a verage 60-day platelet transfusion cost per patient was $4,000 for aut ologous PBSC and $11,000 for allogeneic BM transplants. It was found t hat 11% of all patients had a significant hemorrhagic event during the first 60 days posttransplant, contributing to death in 2% of patients . In conclusion, clinical variables influencing platelet recovery shou ld be considered in the design and interpretation of clinical strategi es to accelerate recovery. Enhancing platelet recovery is not likely t o have a significant impact on 60-day mortality but could significantl y decrease health care costs and potentially improve patient quality o f life. (C) 1998 by The American Society of Hematology.