Transfusion burden following reduced intensity allogeneic hematopoietic cell transplantation: Impact of donor type

Sitalakshmi Subramanian, Claudia Cohn, Todd DeFor, Julie Welbig, Claudio Brunstein, Najla El Jurdi, Daniel Weisdorf

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)2064-2074
Number of pages11
Issue number7
Early online dateApr 26 2021
StatePublished - Jul 2021

Bibliographical note

Funding Information:
The authors thank American Society of Hematology Visiting Scholar Program for funding.

Publisher Copyright:
© 2021 AABB.


  • haploidentical
  • hematopoietic stem cell transplantation
  • transfusion burden
  • transfusion independence
  • Humans
  • Middle Aged
  • Blood Transfusion/economics
  • Parents
  • Male
  • Living Donors
  • Allografts
  • Adult
  • Female
  • Unrelated Donors
  • Hemorrhage/therapy
  • Infant, Newborn
  • Siblings
  • Blood Platelets
  • Neutrophils
  • Hematopoietic Stem Cell Transplantation
  • Graft Survival
  • Transplantation Conditioning/methods
  • Blood Cell Count
  • Cord Blood Stem Cell Transplantation
  • Procedures and Techniques Utilization
  • HLA Antigens/analysis
  • Adolescent
  • Aged
  • Tissue Donors
  • Transplantation, Haploidentical
  • Histocompatibility

PubMed: MeSH publication types

  • Research Support, Non-U.S. Gov't
  • Journal Article


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