Autologous stem-cell transplantation (ASCT) can be safely performed without transfusion support, a new study published online early in the Journal of Clinical Oncology has shown.
Although ASCT with hematopoietic support until marrow engraftment has been shown to be curative in many patients with multiple myeloma and relapsed lymphoma, treatment challenges arise when patients, particularly Jehovah’s Witnesses, refuse blood products.
Therefore, researchers sought to evaluate the safety of high-dose chemotherapy and ASCT without transfusions.
Researchers enrolled 125 patients total, 55 with lymphoma, 68 with multiple myeloma, and 2 with amyloidosis. All patients first received intravenous iron and erythropoietin to increase hemoglobin pretransplantation, as well as cytokine mobilization of stem-cells.
Before starting high-dose chemotherapy, hemoglobin and platelet levels had to be approaching 11 g/dL and 100 x 103/μ/L, respectively.
After chemotherapy and ASCT, patients received a combination of aminocaproic acid, erythropoietin, granulocyte colony-stimulating factor, and phytonadione.
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Results showed that there two major and 15 minor bleeding complications. The median decrease in hemoglobin was 5.0 g/dL and the median number of days with platelet count less than 10 x 103/μ/L was 3.
The median hemoglobin and platelet nadirs were 7.0 g/dL and 5.0 x 103/μ/L, respectively. Researchers also observed cardiac complications in 32% of patients and treatment-related deaths in 4.8% of patients.
The findings suggest that a platelet transfusion trigger of ≤5 × 103/μL may be appropriate in certain patients and researchers found that cardiac monitoring and pharmacotherapy were effective at managing cardiac complications.