In a trial conducted by German hematology and oncology researchers, and reported in The Lancet, therapeutic platelet transfusion may be more appropriate than prophylactic transfusion for some patients with hematological malignancies.
Prophylactic transfusions, triggered by platelet counts below 10,000 per microliter, have been a standard of care for patients with severe thrombocytopenia. This standard has persisted in spite of observational studies suggesting that therapeutic platelet transfusions may be sufficient and safe for these patients.
This randomized trial involved 391 patients. Each patient was undergoing chemotherapy for acute myeloid leukemia or autologous hematopoietic stem-cell transplantation. Study participants were assigned to receive either, prophylactic platelets when the platelet count was below 10,000 per microliter, or therapeutic platelets when bleeding occurred.
Patients undergoing therapeutic transfusion had 33.5% fewer platelet transfusions than those assigned to prophylactic transfusion.
Between the two groups, there were no significant differences in the number of red blood cell transfusions, days with thrombocytopenia, length of hospital stay, transfusion side-effects, and overall survival. However, the risk of grade 2 or higher bleeding was elevated in patients who received therapeutic transfusions. Nearly all patients experiencing hemorrhage had no long-term consequences. Patients with acute myeloid leukemia faced a higher risk of non-fatal grade 4 bleeding if they had received therapeutic transfusions. However, patients with either form of transfusion who had undergone autologous transplantation rarely experienced bleeding of grade 3 or higher.
The researchers noted that there was no clear relationship between platelet count – the trigger for prophylactic transfusion – and the risk of major life-threatening bleeding.
Dr. Hannes Wandt was the lead author on this study. He explains the study’s significance:
“This study provides us with additional arguments and evidence that routine prophylactic platelet transfusions can be reduced substantially. Platelet transfusions should not be the reflex of any arbitrary platelet-count threshold but more the consequence of the individual patient’s bleeding risk that depends on his history, clinical bleeding signs and symptoms.”
In summary, the research team noted that therapeutic transfusion could be safely implemented as a new strategy among patients after autologous stem-cell transplantation. However, they cautioned that prophylactic transfusion may be the safest strategy for patients with acute myeloid leukemia.
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Reference
1. Wandt H, Schaefer-Eckart K, Wendelin K, Pilz B, Wilhelm M, Thalheimer M, Mahlknecht U, Ho A, Schaich M, Kramer M, Kaufmann M, Leimer L, Schwerdtfeger R, Conradi R, Dolken G, Klenner A, Hanel M, Herbst R, Junghanss C, Ehninger G. Therapeutic platelet transfusion versus routine prophylactic transfusion in patients with haematological malignancies: an open-label, multicentre, randomised study. Lancet 2012;380: 1309-16.
