Expected individual benefit of prophylactic platelet transfusions in hemato‐oncology patients based on bleeding risks

Journal Article · 14 July 2021 · Transfusion (Philadelphia)

DOI: https://doi.org/10.1111/trf.16587 · OSTI ID:1808219

Cornelissen, Loes L.  ^[1]; Caram‐Deelder, Camila  ^[2]; Fustolo‐Gunnink, Susanna F.  ^[3]; Groenwold, Rolf H. H.  ^[4]; Stanworth, Simon J.  ^[5]; Zwaginga, Jaap Jan  ^[6]; van der Bom, Johanna G.  ^[2]

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1. Jon J van Rood Center for Clinical Transfusion Research, Sanquin/LUMC Leiden The Netherlands, Department of Hematology Leiden University medical Center Leiden The Netherlands, Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands
2. Jon J van Rood Center for Clinical Transfusion Research, Sanquin/LUMC Leiden The Netherlands, Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands
3. Jon J van Rood Center for Clinical Transfusion Research, Sanquin/LUMC Leiden The Netherlands, Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands, Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam University Medical Center (UMC) University of Amsterdam Amsterdam The Netherlands
4. Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands
5. Transfusion Medicine, NHS Blood and Transplant (NHSBT) Oxford UK, Department of Haematology Oxford University Hospitals NHS Foundation Trust Oxford UK, Radcliffe Department of Medicine University of Oxford Oxford UK, NIHR Oxford Biomedical Research Centre Oxford UK
6. Jon J van Rood Center for Clinical Transfusion Research, Sanquin/LUMC Leiden The Netherlands, Department of Hematology Leiden University medical Center Leiden The Netherlands

Abstract Background Prophylactic platelet transfusions prevent bleeding in hemato‐oncology patients, but it is unclear how any benefit varies between patients. Our aim was to assess if patients with different baseline risks for bleeding benefit differently from a prophylactic platelet transfusion strategy. Study design and methods Using the data from the randomized controlled TOPPS trial (Trial of Platelet Prophylaxis), we developed a prediction model for World Health Organization grades 2, 3, and 4 bleeding risk (defined as at least one bleeding episode in a 30 days period) and grouped patients in four risk‐quartiles based on this predicted baseline risk. Predictors in the model were baseline platelet count, age, diagnosis, disease modifying treatment, disease status, previous stem cell transplantation, and the randomization arm. Results The model had a c‐statistic of 0.58 (95% confidence interval [CI] 0.54–0.64). There was little variation in predicted risks (quartiles 46%, 47%, and 51%), but prophylactic platelet transfusions gave a risk reduction in all risk quartiles. The absolute risk difference (ARD) was 3.4% (CI −12.2 to 18.9) in the lowest risk quartile (quartile 1), 7.4% (95% CI −8.4 to 23.3) in quartile 2, 6.8% (95% CI −9.1 to 22.9) in quartile 3, and 12.8% (CI −3.1 to 28.7) in the highest risk quartile (quartile 4). Conclusion In our study, generally accepted bleeding risk predictors had limited predictive power (expressed by the low c‐statistic), and, given the wide confidence intervals of predicted ARD, could not aid in identifying subgroups of patients who might benefit more (or less) from prophylactic platelet transfusion.

• Sponsoring Organization: USDOE
• OSTI ID: 1808219
• Journal Information: Transfusion (Philadelphia), Journal Name: Transfusion (Philadelphia) Journal Issue: 9 Vol. 61; ISSN 0041-1132
• Publisher: Wiley-BlackwellCopyright Statement
• Country of Publication: United States
• Language: English