22 Platelet Engraftment Failure Leads to Poor Overall Survival Even after Neutrophil Engraftment without Relapse

Track: BMT Tandem "Scientific" Meeting
Friday, February 15, 2013, 10:30 AM-12:00 PM
Ballroom A-D (Salt Palace Convention Center)
Fumihiko Kimura, MD, PhD , Division of Hematology, National Defense Medical College, Tokorozawa, Japan
Shinichi Kobayashi, MD, PhD , Division of Hematology, National Defense Medical College, Tokorozawa, Japan
Kazuteru Ohashi, MD, PhD , Division of Hematology, Tokyo Metropolitan Cancer and Infectious diseases Center, Tokyo, Japan
Shuichi Taniguchi, MD, PhD , Department of Hematology, Toranomon Hospital, Tokyo, Japan
Takehiko Mori, MD, PhD , Division of Hematology, Keio University School of Medicine, Tokyo, Japan
Masami Inoue, MD, PhD , Depatment of Pediatrics, Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
Hisashi Sakamaki, MD, PhD , Division of Hematology, Tokyo Metropolitan Cancer and Infectious diseases Center, Tokyo, Japan
Hiromasa Yabe, MD, PhD , Department of Cell Transplantation and Regenerative Medicine, Tokai University School of Medicine, Isehara, Japan
Yasuo Morishima, MD, PhD , Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
Koji Kato, MD, PhD , Department of Pediatric Hematology and Oncology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
Ritsuro Suzuki, MD, PhD , HSCT Data Management & Biostatistics, Nagoya University, Nagoya, Japan
Takahiro Fukuda, MD, PhD , Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan
Platelet engraftment failure is a serious complication leading to poor overall survival and quality of life in stem cell transplantation. Neutrophil engraftment failure is usually associated with failure of platelet engraftment. Relapse of underlying disease such as acute leukemia can delay platelet recovery. Because both of these situations are major causes of poor survival, effect of platelet engraftment on survival is not obvious in patients after neutrophil engraftment without relapse.

We analyzed platelet engraftment in unrelated BMT (UR-BMT), related BMT (Rel-BMT), related PBSCT (Rel-PBSCT), and CBT using transplant outcome database of Japan Society for Hematopoietic Cell Transplantation. Platelet engraftment was defined by the first of three successive days with a non-transfused platelet count of greater than 20x109/L. We excluded cases with neutrophil engraftment failure or relapse before achieving platelet engraftment, because both of them can cause delay of platelet recovery. The study population consisted of 12,101 patients who underwent UR-BMT (3,482), Rel-BMT (3,153), Rel-PBSCT (2,834), or CBT (2,632) for AML, ALL, CML, and MDS. The percentage of platelet recovery (platelet count > 20x109/L, without transfusion) in UR-BMT, Rel-BMT, Rel-PBSCT, and CBT was 89%, 94%, 93%, and 84%, and the median days of recovery after transplantation was 28, 24, 18, and 44 days, respectively. Multivariate Cox proportional hazards regression analysis revealed that advanced stage of disease and poor performance status (≥ grade 2) were common risk factors for platelet engraftment failure in the four donor sources. Lower cell dose was a significant risk factor in UR-BMT and CBT. HLA-mismatched graft was also significant in the transplantation other than CBT. We analyzed 1 year overall survival in patients alive with or without platelet engraftment every 10 days from 20 days to 100 days after transplantation. Patients without platelet recovery showed significant poor survival than those with the recovery (Log-rank test, p<0.001) at every point except day 20 in CBT. The estimated 1 year overall survival of patients alive at day 100 with or without platelet recovery is 79% vs 62% (UR-BMT), 81% vs 62% (Rel-BMT), 72% vs 57% (Rel-PBSCT), 77% vs 57% (CBT), and the probability of eventually achieving platelet count >20x109/L in patients without recovery at day 100 was 25%, 31%, 34%, and 44%, respectively. Multivariate analysis confirmed that platelet recovery was significantly associated with survival.

In conclusion, platelet engraftment predicted overall survival even excluding neutrophil engraftment failure and early relapse in BMT, related PBSCT, and CBT.

See more of: Oral Abstracts - Session G - Allogeneic Transplants
See more of: BMT Tandem "Scientific" Meeting
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