A multicenter study of platelet recovery and utilization in patients after myeloablative therapy and hematopoietic stem cell transplantation

Steven H. Bernstein, Auayporn P. Nademanee, Julie M. Vose, Guido Tricot, Joseph W. Fay, Robert S. Negrin, John DiPersio, Gabriela Rondon, Richard Champlin, Michael J. Barnett, Kenneth Cornetta, Geoffrey P. Herzig, William Vaughan, George Geils, Armand Keating, Hans Messner, Steven N. Wolff, Kenneth B. Miller, Charles Linker, Mitchell Cairo & 4 others Susan Hellmann, Mark Ashby, Scott Stryker, Richard A. Nash

Research output: Contribution to journalArticle

100 Citations (Scopus)

Abstract

An observational study was conducted at 18 transplant centers in the United States and Canada to characterize the platelet recovery of patients receiving myeloablative therapy and stem cell transplantation and to determine the clinical variables influencing recovery, determine platelet utilization and cost, and incidence of hemorrhagic events. The study included 789 evaluable patients transplanted in 1995. Clinical, laboratory, and outcome data were obtained from the medical records. Variables associated with accelerated recovery in multivariate models included (1) higher CD34 count; (2) higher platelet count at the start of myeloablative therapy; (3) graft from an HLA-identical sibling donor; and (4) prior stem cell transplant. Variables associated with delayed recovery were (1) prior radiation therapy; (2) posttransplant fever; (3) hepatic veno-occlusive disease; and (4) use of posttransplant growth factors. Disease type also influenced recovery. Recipients of peripheral blood stem cells (PBSC) had faster recovery and fewer platelet transfusion days than recipients of bone marrow (BM). The estimated average 60-day platelet transfusion cost per patient was $4,000 for autologous PBSC and $11,000 for allogeneic BM transplants. It was found that 11% of all patients had a significant hemorrhagic event during the first 60 days posttransplant, contributing to death in 2% of patients. In conclusion, clinical variables influencing platelet recovery should be considered in the design and interpretation of clinical strategies to accelerate recovery. Enhancing platelet recovery is not likely to have a significant impact on 60-day mortality but could significantly decrease health care costs and potentially improve patient quality of life.

Original languageEnglish (US)
Pages (from-to)3509-3517
Number of pages9
JournalBlood
Volume91
Issue number9
StatePublished - May 1 1998
Externally publishedYes

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Transplantation (surgical)
Hematopoietic Stem Cell Transplantation
Platelets
Stem cells
Multicenter Studies
Blood Platelets
Recovery
Transplants
Platelet Transfusion
Therapeutics
Hepatic Veno-Occlusive Disease
Bone Marrow
Costs and Cost Analysis
Bone
Stem Cell Transplantation
Blood
Platelet Count
Clinical laboratories
Health Care Costs
Canada

ASJC Scopus subject areas

  • Hematology

Cite this

Bernstein, S. H., Nademanee, A. P., Vose, J. M., Tricot, G., Fay, J. W., Negrin, R. S., ... Nash, R. A. (1998). A multicenter study of platelet recovery and utilization in patients after myeloablative therapy and hematopoietic stem cell transplantation. Blood, 91(9), 3509-3517.

A multicenter study of platelet recovery and utilization in patients after myeloablative therapy and hematopoietic stem cell transplantation. / Bernstein, Steven H.; Nademanee, Auayporn P.; Vose, Julie M.; Tricot, Guido; Fay, Joseph W.; Negrin, Robert S.; DiPersio, John; Rondon, Gabriela; Champlin, Richard; Barnett, Michael J.; Cornetta, Kenneth; Herzig, Geoffrey P.; Vaughan, William; Geils, George; Keating, Armand; Messner, Hans; Wolff, Steven N.; Miller, Kenneth B.; Linker, Charles; Cairo, Mitchell; Hellmann, Susan; Ashby, Mark; Stryker, Scott; Nash, Richard A.

In: Blood, Vol. 91, No. 9, 01.05.1998, p. 3509-3517.

Research output: Contribution to journalArticle

Bernstein, SH, Nademanee, AP, Vose, JM, Tricot, G, Fay, JW, Negrin, RS, DiPersio, J, Rondon, G, Champlin, R, Barnett, MJ, Cornetta, K, Herzig, GP, Vaughan, W, Geils, G, Keating, A, Messner, H, Wolff, SN, Miller, KB, Linker, C, Cairo, M, Hellmann, S, Ashby, M, Stryker, S & Nash, RA 1998, 'A multicenter study of platelet recovery and utilization in patients after myeloablative therapy and hematopoietic stem cell transplantation', Blood, vol. 91, no. 9, pp. 3509-3517.
Bernstein SH, Nademanee AP, Vose JM, Tricot G, Fay JW, Negrin RS et al. A multicenter study of platelet recovery and utilization in patients after myeloablative therapy and hematopoietic stem cell transplantation. Blood. 1998 May 1;91(9):3509-3517.
Bernstein, Steven H. ; Nademanee, Auayporn P. ; Vose, Julie M. ; Tricot, Guido ; Fay, Joseph W. ; Negrin, Robert S. ; DiPersio, John ; Rondon, Gabriela ; Champlin, Richard ; Barnett, Michael J. ; Cornetta, Kenneth ; Herzig, Geoffrey P. ; Vaughan, William ; Geils, George ; Keating, Armand ; Messner, Hans ; Wolff, Steven N. ; Miller, Kenneth B. ; Linker, Charles ; Cairo, Mitchell ; Hellmann, Susan ; Ashby, Mark ; Stryker, Scott ; Nash, Richard A. / A multicenter study of platelet recovery and utilization in patients after myeloablative therapy and hematopoietic stem cell transplantation. In: Blood. 1998 ; Vol. 91, No. 9. pp. 3509-3517.
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abstract = "An observational study was conducted at 18 transplant centers in the United States and Canada to characterize the platelet recovery of patients receiving myeloablative therapy and stem cell transplantation and to determine the clinical variables influencing recovery, determine platelet utilization and cost, and incidence of hemorrhagic events. The study included 789 evaluable patients transplanted in 1995. Clinical, laboratory, and outcome data were obtained from the medical records. Variables associated with accelerated recovery in multivariate models included (1) higher CD34 count; (2) higher platelet count at the start of myeloablative therapy; (3) graft from an HLA-identical sibling donor; and (4) prior stem cell transplant. Variables associated with delayed recovery were (1) prior radiation therapy; (2) posttransplant fever; (3) hepatic veno-occlusive disease; and (4) use of posttransplant growth factors. Disease type also influenced recovery. Recipients of peripheral blood stem cells (PBSC) had faster recovery and fewer platelet transfusion days than recipients of bone marrow (BM). The estimated average 60-day platelet transfusion cost per patient was $4,000 for autologous PBSC and $11,000 for allogeneic BM transplants. It was found that 11{\%} of all patients had a significant hemorrhagic event during the first 60 days posttransplant, contributing to death in 2{\%} of patients. In conclusion, clinical variables influencing platelet recovery should be considered in the design and interpretation of clinical strategies to accelerate recovery. Enhancing platelet recovery is not likely to have a significant impact on 60-day mortality but could significantly decrease health care costs and potentially improve patient quality of life.",
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AU - Tricot, Guido

AU - Fay, Joseph W.

AU - Negrin, Robert S.

AU - DiPersio, John

AU - Rondon, Gabriela

AU - Champlin, Richard

AU - Barnett, Michael J.

AU - Cornetta, Kenneth

AU - Herzig, Geoffrey P.

AU - Vaughan, William

AU - Geils, George

AU - Keating, Armand

AU - Messner, Hans

AU - Wolff, Steven N.

AU - Miller, Kenneth B.

AU - Linker, Charles

AU - Cairo, Mitchell

AU - Hellmann, Susan

AU - Ashby, Mark

AU - Stryker, Scott

AU - Nash, Richard A.

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N2 - An observational study was conducted at 18 transplant centers in the United States and Canada to characterize the platelet recovery of patients receiving myeloablative therapy and stem cell transplantation and to determine the clinical variables influencing recovery, determine platelet utilization and cost, and incidence of hemorrhagic events. The study included 789 evaluable patients transplanted in 1995. Clinical, laboratory, and outcome data were obtained from the medical records. Variables associated with accelerated recovery in multivariate models included (1) higher CD34 count; (2) higher platelet count at the start of myeloablative therapy; (3) graft from an HLA-identical sibling donor; and (4) prior stem cell transplant. Variables associated with delayed recovery were (1) prior radiation therapy; (2) posttransplant fever; (3) hepatic veno-occlusive disease; and (4) use of posttransplant growth factors. Disease type also influenced recovery. Recipients of peripheral blood stem cells (PBSC) had faster recovery and fewer platelet transfusion days than recipients of bone marrow (BM). The estimated average 60-day platelet transfusion cost per patient was $4,000 for autologous PBSC and $11,000 for allogeneic BM transplants. It was found that 11% of all patients had a significant hemorrhagic event during the first 60 days posttransplant, contributing to death in 2% of patients. In conclusion, clinical variables influencing platelet recovery should be considered in the design and interpretation of clinical strategies to accelerate recovery. Enhancing platelet recovery is not likely to have a significant impact on 60-day mortality but could significantly decrease health care costs and potentially improve patient quality of life.

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