Secondary failure of platelet recovery after hematopoietic stem cell transplantation

After primary recovery of platelet counts after transplantation, there can be a late persistent decline called secondary failure of platelet recovery (SFPR), which may occur although the counts of other cell lineages remain w ithin the normal range. SFPR was defined as a decline of platelet counts be low 20,000/muL, for 7 consecutive days or requiring transfusion support aft er achieving sustained platelet counts greater than or equal to 50,000/muL without transfusions for 7 consecutive days after hematopoietic stem cell t ransplantation (HSCT). The study population consisted of 2871 consecutive p atients receiving transplants from January 1990 to March 1997. After primar y recovery of platelet counts, SFPR not due to relapse of the underlying di sease was observed in 285 of 1401 (20%) patients undergoing allogeneic tran splantation and 36 (8%) of 444 patients undergoing autologous transplantati on, with a median time of onset after transplantation at day 63 (range, day 21-156) and day 44 (range, day 24-89), respectively. Concomitant neutropen ia was seen in 57 (20%) of 285 patients undergoing allogeneic HSCT and 7 (1 9%) of 36 patients undergoing autologous HSCT with SFPR. By multivariable a nalysis, the following were factors significantly associated with SFPR afte r allogeneic HSCT: a transplant from an unrelated donor; a graft-versus-hos t disease (GVHD) prophylaxis other than methotrexate and cyclosporine; deve lopment of grade 2 through 4 acute GVHD; impaired renal or liver function; conditioning with the combination of busulfan, cyclophosphamide, and total body irradiation; stem cell dose; and infections. Cytomegalovirus infection after engraftment and source of stem cells were the only significant risk factors after autologous HSCT. The hazard rate of death was significantly h igher in patients who experienced SFPR (hazard ratio = 2.6 for allogeneic H SCT; hazard ratio = 2.2 for autologous HSCT). SFPR was associated with seri ous complications and poor outcome after transplantation. The identificatio n of the characteristics and risk factors for SFPR could improve patient co unseling and management and lead to the design of effective treatment strat egies.