Decreased transfusion requirements for patients receiving nonmyeloablativecompared with conventional peripheral blood stem cell transplants from HLA-identical siblings

Red blood cell (RBC) and platelet transfusion requirements in patients give n nonmyeloablative versus conventional peripheral blood stem cell (PBSC) tr ansplants from HLA-matched siblings were compared. Between December 1997 an d March 2000, 40 patients, aged 21 to 67 years (median 51), with hematologi c malignancies underwent nonmyeloablative allografts after either 2 Gy tota l body irradiation alone (n = 30) or 2 Gy total body irradiation preceded b y fludarabine 30 mg/m(2)/d on days -4, -3, and -2 (n = 10). All received po stgrafting mycophenolate mofetil and cyclosporine. Controls included 67 con current patients, aged 23 to 66 years (median, 46 years), given conventiona l PBSC transplants following high-dose conditioning and postgrafting methot rexate and cyclosporine. Among patients given nonmyeloablative transplants, 23% required platelet transfusions compared with 100% among patients given conventional grafts (P < .0001). Further, the number of platelet units giv en to nonmyeloablative recipients was reduced, with a median of 0 (range, 0 to 214) compared with a median of 24 (range, 4 to 358) after conventional transplantation (P < .0001). Sixty-three percent of nonmyeloablative recipi ents required RBC transfusions compared with 96% of those with conventional grafts (P = .0001). The number of RBC units transfused was also reduced, w ith a median of 2 (range, 0 to 50) compared with 6 (range, 0 to 34) after c onventional transplantation (P = .0001). High transfusion requirements befo re transplantation and donor-recipient ABO incompatibility increased transf usion requirements In both patient groups, though neither significantly inf luenced the outcome of the analysis. Neither patient age, splenomegaly at t ransplantation, development of graft-versus-host disease, nor posttransplan tation cytomegalovirus antigenemia or cytomegalovirus disease had statistic ally significant influences on posttransplantation transfusions. (C) 2001 b y The American Society of Hematology.