SAFETY AND COST-EFFECTIVENESS OF A 10 X 10(9) L TRIGGER FOR PROPHYLACTIC PLATELET TRANSFUSIONS COMPARED WITH THE TRADITIONAL 20 X 10(9)/L TRIGGER - A PROSPECTIVE COMPARATIVE TRIAL IN 105 PATIENTS WITH ACUTE MYELOID-LEUKEMIA/

In 105 consecutive patients with de novo acute myeloid leukemia (Frenc h-American-British M3 excluded), we compared prospectively the risk of bleeding complications, the number of platelet and red blood cell tra nsfusions administered, and the costs of transfusions using two differ ent prophylactic platelet transfusion protocols. Two hundred sixteen c ycles of induction or consolidation chemotherapy and 3,843 days of thr ombocytopenia less than 25 x 10(9)/L were evaluated. At the start of t he study, each of the 17 participating centers decided whether they wo uld use a 10 x 10(9)/L prophylactic platelet transfusion trigger (grou p A/8 centers) or a 20 x 10(9)/L trigger (group B/9 centers). Bleeding complications (World Health Organization grade 2-4) during treatment cycles were comparable in the two groups: 20 of 110 (18%) in group A a nd 18 of 106 (17%) in group B (P = .8), Serious bleeding events (grade 3-4) were generally not related to the patient's platelet count but w ere the consequence of local lesions and plasma coagulation factor def iciencies due to sepsis. Eighty-six percent of the serious bleeding ep isodes occurred during induction chemotherapy. No patient died of a bl eeding complication. There were no significant differences in the numb er of red blood cell transfusions administered between the two groups, but there were significant differences in the number of platelet tran sfusions administered per treatment cycle: pooled random donor platele t concentrates averaged 15.4 versus 25.4 (P < .01) and apheresis plate lets averaged 3.0 versus 4.8 (P < .05) for group A versus group B, res pectively. This resulted in the cost of platelet therapy being one thi rd lower in group A compared with group B without any associated incre ase in bleeding risk. (C) 1998 by The American Society of Hematology.