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.
Bibliographical noteFunding Information:
The authors thank American Society of Hematology Visiting Scholar Program for funding.
© 2021 AABB.
- hematopoietic stem cell transplantation
- transfusion burden
- transfusion independence
- Middle Aged
- Blood Transfusion/economics
- Living Donors
- Unrelated Donors
- Infant, Newborn
- Blood Platelets
- Hematopoietic Stem Cell Transplantation
- Graft Survival
- Transplantation Conditioning/methods
- Blood Cell Count
- Cord Blood Stem Cell Transplantation
- Procedures and Techniques Utilization
- HLA Antigens/analysis
- Tissue Donors
- Transplantation, Haploidentical
PubMed: MeSH publication types
- Research Support, Non-U.S. Gov't
- Journal Article