Impact of prophylactic platelet transfusions on bleeding events in patients with hematologic malignancies: a subgroup analysis of a randomized trial (CME). Issue 10 (14th April 2014)

• Record Type: Journal Article
• Authors: Stanworth, Simon J.; Estcourt, Lise J.; Llewelyn, Charlotte A.; Murphy, Michael F.; Wood, Erica M.; TOPPS Study Investigators
• Is Part Of: Transfusion. Volume 54:Issue 10(2014)
• Page Start: 2385
• Page End: 2393
• Publication Date: 2014-04-14
• Subjects: Hematology -- Periodicals; Blood -- Transfusion -- Periodicals; Blood Group Antigens -- Periodicals; Blood Preservation -- Periodicals; Blood Transfusion -- Periodicals; 615
• DOI: 10.1111/trf.12646
• Languages: English
• ISSNs: 0041-1132

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="trf12646-sec-0001" sec-type="section"> <title>Background</title> <p>A recent randomized trial compared a policy of no prophylaxis with a policy of prophylactic platelet (PLT) transfusions at counts of fewer than 10 × 10<sup>9</sup>/L in patients with hematologic malignancies. The results suggested the effectiveness of prophylactic PLT transfusions may vary according to patient diagnosis and treatment plan.</p> </sec> <sec id="trf12646-sec-0002" sec-type="section"> <title>Study Design and Methods</title> <p>This article presents full subgroup analyses and compares treatment effects between autologous hematopoietic stem cell transplantation (autoHSCT; n = 421) and chemotherapy/allogeneic HSCT (chemo/alloHSCT; n = 179) patients.</p> </sec> <sec id="trf12646-sec-0003" sec-type="section"> <title>Results</title> <p>Prespecified subgroup analysis found that the reduction in proportion of patients experiencing WHO Grade 2 to 4 bleeds (main trial outcome) seen in the prophylaxis arm was of greater magnitude in chemo/alloHSCT than autoHSCT patients (interaction p = 0.04). Analysis of secondary outcomes showed a shorter time to first bleeding episode with no prophylaxis in the chemo/alloHSCT group (hazard ratio, 1.84; 95% confidence interval CI, 1.21‐2.79; p = 0.004) compared to the autoHSCT group (hazard ratio, 1.12; 95% CI, 0.85‐1.48; p = 0.4; interaction p = 0.08). The increased number of days with Grade 2 to 4 bleeds with a no‐prophylaxis policy was similar in chemo/alloHSCT (rate ratio, 1.89; 95% CI, 1.10‐3.26) and in autoHSCT patients (rate ratio, 1.43; 95% CI, 1.04‐1.97). Both subgroups showed significant reductions in PLT transfusions with a no‐prophylaxis strategy.</p> </sec> <sec id="trf12646-sec-0004" sec-type="section"> <title>Conclusion</title> <p>There is evidence that the effectiveness of prophylactic PLT transfusions may differ between subgroups, with chemo/alloHSCT patients receiving prophylactic PLT transfusions appearing to show a greater reduction in bleeding outcomes compared to patients following a no‐prophylaxis policy.</p> </sec> </abstract>