Abstract

Transfusion independence is an important goal of hematopoietic stem cell transplantation (HSCT) for acute leukemia. We hypothesized that time to red blood cell (RBC) and platelet (PLT) transfusion independence would differ depending on the source of stem cells and the intensity of the preparative regimen. We retrospectively analyzed all transfusions administered to 146 acute leukemia patients who underwent a HSCT at our institution receiving a sibling (SIB) peripheral blood stem cell (PBSC) or an unrelated umbilical cord blood (UCB) graft, between 7/01 and 12/03. Median age was 35.6 yrs. (range 0.5–69.6) and 88 (60%) were male. Ninety-eight (67%) patients (pts) received an UCB and 48 (33%) a SIB graft. Thirty-four (71%) SIB and 56 (57%) UCB pts. received a myeloablative preparative regimen. Median time to RBC independence among all SIB PBSC recipients (n= 25) was 56 days [myeloablative conditioning (MA) (n= 18) 52.5 days; non-myeloablative conditioning (NMA) (n=7) 58 days], and the cumulative incidence of RBC independence at 6 months was 52% (95%CI: 39–69) [MA 53% (95%CI: 38–73); NMA 43% (95%CI: 28–89)]. For recipients of a UCB graft (n= 58) median time to RBC independence was 47 days [MA (n= 38) 56.5 days; NMA (n=20) 41.5 days], and the cumulative incidence of RBC independence at 6 months was 59% (95%CI: 50–70) [MA 68% (95%CI: 56–82); NMA 48% (95%CI: 34–66)]. Median time to platelet (PLT) independence among all SIB PBSC recipients (n= 27) was 25 days [MA (n= 19) 26 days; NMA (n=8) 12 days], and the cumulative incidence of PLT independence at 6 months was 56% (95%CI: 44–73) [MA 56% (95%CI: 41–76); NMA 57% (95%CI: 35–94)]. There was no statistically significant difference in the cumulative incidence of RBC independence between SIB PBSC vs. UCB (p=0.49), and MA vs. NMA (p=0.18). For recipients of an UCB graft (n= 68) median time to PLT independence was 43 days [MA (n= 44) 47.5 days; NMA (n=24) 39 days], and the cumulative incidence of PLT independence at 6 months was 69% (95%CI: 61–79) [MA 79% (95%CI: 68–90); NMA 57% (95%CI: 44–75)]. There was no statistically significant difference in the cumulative incidence of PLT independence between SIB PBSC vs. UCB (p=0.52), and MA vs. NMA (p=0.21). In multivariate analysis, the source of HSC and intensity of the preparative regimen were not predictors of RBC or PLT independence. This analysis shows similar RBC and PLT utilization in recipients of SIB PBSC and UCB following either MA or NMA conditioning. The substantial costs associated with transfusion support for allogeneic HSC transplant are similar in SIB PBSCT and UCB graft recipients.

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