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Post-Transplant Complications

Bleeding risk and platelet transfusion refractoriness in patients with acute myelogenous leukemia who undergo autologous stem cell transplantation

Bone Marrow Transplantation volume 26, pages 315–320 (2000)Cite this article

Abstract

Therapy for acute myelogenous leukemia can be complicated by alloimmunization to histocompatibility antigens (HLA), with resultant refractoriness to platelet transfusions. Autologous peripheral blood or bone marrow stem cell transplantation (referred here collectively as ‘autoBMT’) is emerging as a standard consolidative strategy in acute myelogenous leukemia (AML). We had noted life-threatening bleeding associated with platelet transfusion refractoriness following autoBMT; we therefore retrospectively analyzed 39 AML patients for this complication following BMT. All patients received high-dose chemoradiotherapy, followed by infusion of allogeneic sibling donor (n = 12, alloBMT) or autologous (n = 27, autoBMT) stem cells. HLA alloimmunization was assessed if patients were suspected of immune refractoriness to random donor platelet transfusions. Within 100 days of stem cell infusion, one of three alloBMT and six of 12 autoBMT recipients tested were HLA alloimmunized (not statistically significant, NS). Five of six HLA alloimmunized autoBMT patients experienced delayed bleeding, which contributed to their demise while still in remission (P < 0.001). increased platelet requirements in hla alloimmunized autobmt recipients were observed between days 61 and 100 post-bmt, at a median of 211 platelet transfusions vs 0 in non-alloimmunized autoBMT patients (P < 0.01) and 17 in allobmt patients. our data suggest that platelet transfusion refractoriness, when associated with hla alloimmunization, is a risk factor for increased platelet transfusion requirements, delayed bleeding, and poor outcome following autobmt for aml. Bone Marrow Transplantation (2000) 26, 315–320.

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Acknowledgements

We would like to thank Ms Jane Uhlmann for her kind support in obtaining platelet transfusion data on several patients. We are very grateful to Todd Defor, from the Adult Blood and Marrow Transplant Program, for his assistance with statistical analyses. We are also very grateful to Drs Linda J Burns, Dale Hammerschmidt, and Jeffrey McCullough for critical review of this manuscript. Sherry Kuhn and Diane Bjork supplied expert secretarial assistance.

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Author notes

  1. AA Toor

    Present address: Dept of Myeloma and Transplantation, University of Arkansas, Little Rock, 72205, AR, USA

  2. SY Choo

    Present address: Dept of Pathology, University of Oklahoma Health Sciences Center, 940 Stanton L Young Blvd, BSMB 451, Oklahoma City, 73104, OK, USA

Authors and Affiliations

  1. Department of Medicine, University of Minnesota, Minneapolis, MN, USA

    AA Toor & JA Little

  2. Department of Laboratory Medicine and Pathology, Minneapolis, MN, USA

    SY Choo

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  1. AA Toor
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Toor, A., Choo, S. & Little, J. Bleeding risk and platelet transfusion refractoriness in patients with acute myelogenous leukemia who undergo autologous stem cell transplantation. Bone Marrow Transplant 26, 315–320 (2000). https://doi.org/10.1038/sj.bmt.1702490

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