Intensity of endogenous thrombocytopenia after autologous stem cell transplantation in patients prophylactically transfused with platelets

by Selleckchem | Jun 26 2023

Background and objectives: Large clinical trials have demonstrated that some patient groups with hypoproliferative thrombocytopenia benefit from prophylactic platelet transfusions, while in others, a therapeutic transfusion regimen might be sufficient. The remaining capacity to generate endogenous platelets might be helpful to select the platelet transfusion regimen. We assessed whether the recently described method of digital droplet polymerase chain reaction (PCR) can be used to assess the endogenous platelet levels in two groups of patients undergoing high-dose chemotherapy with autologous stem cell transplantation (ASCT).

Materials and methods: Multiple myeloma (n = 22) patients received high-dose melphalan alone (HDMA); lymphoma patients (n = 15) received BEAM or TEAM (B/TEAM) conditioning. Patients with a total platelet count <10 G/L received prophylactic apheresis platelet concentrates. Daily endogenous platelet counts were measured by digital droplet PCR for at least 10 days post-ASCT.

Results: Post-transplantation B/TEAM patients received their first platelet transfusion on average 3 days earlier than HDMA patients (p < 0.001) and required about twofold more platelet concentrates (p < 0.001). The endogenous platelet count fell ≤5 G/L for a median of 115 h (91-159; 95% confidence interval) in B/TEAM-treated patients compared to 12.6 h (0-24) (p < 0.0001) in HDMA-treated patients. Multivariate analysis confirmed this profound effect of the high-dose regimen (p < 0.001). The CD-34+ -cell dose in the graft was inversely correlated with the intensity of endogenous thrombocytopenia in B/TEAM-treated patients.

Conclusion: Monitoring endogenous platelet counts detects the direct effects of myelosuppressive chemotherapies on platelet regeneration. This approach may help to develop a platelet transfusion regimen tailored to specific patient groups.

Comments:

The objective of this study was to evaluate the use of digital droplet polymerase chain reaction (PCR) to assess endogenous platelet levels in two groups of patients undergoing high-dose chemotherapy with autologous stem cell transplantation (ASCT). The study included patients with multiple myeloma who received high-dose melphalan alone (HDMA) and patients with lymphoma who received BEAM or TEAM (B/TEAM) conditioning. The researchers measured daily endogenous platelet counts using digital droplet PCR for at least 10 days after ASCT.

The results showed that B/TEAM patients received their first platelet transfusion, on average, 3 days earlier than HDMA patients and required approximately twice as many platelet concentrates. The endogenous platelet count dropped to ≤5 G/L for a median of 115 hours in B/TEAM-treated patients compared to 12.6 hours in HDMA-treated patients. Multivariate analysis confirmed the significant impact of the high-dose regimen on platelet levels. Additionally, the study found an inverse correlation between the CD34+ cell dose in the graft and the severity of endogenous thrombocytopenia in B/TEAM-treated patients.

The authors concluded that monitoring endogenous platelet counts using digital droplet PCR can effectively detect the direct effects of myelosuppressive chemotherapies on platelet regeneration. This approach has the potential to assist in the development of a tailored platelet transfusion regimen for specific patient groups.