Incidence, cost, and outcomes of bleeding and chemotherapy dose modification among solid tumor patients with chemotherapy-induced thrombocytopenia

Purpose: To describe the incidence and outcomes of bleeding and chemotherap y dose modifications associated with chemotherapy-induced thrombocytopenia (platelets < 50,000/<mu>L). Patients and Methods: Six hundred nine patients with solid tumors or lympho ma were followed-up during 1,262 chemotherapy cycles complicated by thrombo cytopenia for development of bleeding, delay or dose reduction of the subse quent cycle, survival, land resource utilization. The association between s urvival and bleeding or dose modification was examined using the Cox propor tional hazards model. Predisposing factors were identified by logistic regr ession. Results: Bleeding occurred during 9% of cycles among patients with previous bleeding episodes (P < .0001), baseline platelets less than 75,000/<mu>L ( p < .0001), bone marrow metastases (P = .001), poor performance status (P = .03), and cisplatin, carboplatin, carmustine or lomustine administration (P = .0002). Major bleeding episodes resulted in shorter survival and higher resource utilization (P < .0001). Chemotherapy delays occurred during 6% of cycles among patients with more than five previous cycles (P = .003), radi otherapy (P =.03), and disseminated disease (P = .04). They experienced sim ilar clinical outcomes but used significantly more resources. Dose reductio ns occurred during 15% of cycles but were not associated with poor clinical outcomes or excess resource utilization. Significantly shorter survival an d higher resource utilization were observed among the 20% of patients who f ailed to achieve an adequate response to platelet transfusion. Conclusion: The incidence of bleeding is low among solid tumor patients ove rall but exceeds 20% in some subgroups. These subgroups are easily identifi able using routinely available clinical information. A clinical prediction rule is being developed. Poor response to platelet transfusion is a clinica lly and financially significant downstream effect of thrombocytopenia and w arrants further investigation.