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Transfusion burden following reduced intensity allogeneic hematopoietic cell transplantation: Impact of donor type
Author(s) -
Subramanian Sitalakshmi,
Cohn Claudia,
DeFor Todd,
Welbig Julie,
Brunstein Claudio,
El Jurdi Najla,
Weisdorf Daniel
Publication year - 2021
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.16413
Subject(s) - medicine , platelet , cumulative incidence , hematopoietic stem cell transplantation , incidence (geometry) , hematopoietic cell , transplantation , gastroenterology , surgery , haematopoiesis , stem cell , biology , physics , optics , genetics
Background Transfusions are essential for allogeneic hematopoietic cell transplant (HCT), yet they are influenced by graft, donor, and other factors. Study design We analyzed transfusions in 165 adult reduced intensity HCTs (2016–2019): HLA matched sibling donor (MSD) (n = 59), matched URD (n = 25), UCB (n = 33), and haploidentical (haplo, n = 48) detailing the cumulative incidence of platelet and RBC transfusion independence, total transfusions (day−10 to day+100) plus transfusion densities (per week) over 110 days. Results Platelet recovery to 20 × 10 9 /L by 6 months occurred in 39/48 (81.25%) haplo recipients (median 33 [range, 0–139]) days vs. 58/59 (98.3%) MSD (median 10 [0–37]), 21/25 (84%) matched URD (median 20 [0–153]), and 29/33 (87.87%) UCB (median 48 [29–166]) days, p < .01. Regression analysis demonstrated a lower likelihood of prompt platelet recovery in matched URD, UCB, or haplo HCTs vs. MSD. Recovery to platelet independence was quickest in MSD (median 8 days [range 0–94]), vs. URD (median 16 days [0–99]), UCB (median 57 [0–94]), or haplo (median 45 [12–97]) days, p < .01. Platelet needs were unaffected by age, conditioning, or acute GVHD. RBC transfusion independence was achieved in 78% of MSD, 64% URD, and 82% UCB, though less frequent (58%) and slowest in haplo recipients, p < .01. All haplo and UCB recipients required platelet transfusions vs. only 51% of MSD and 76% of URD. RBC needs were highest in UCB and haplo HCTs. Discussion The transplant donor influences the transfusion burden with greater platelet and RBC needs in haplo and UCB HCT which directly contributes to increased cost of care.