The Impact of Factors on Transfusion Requirements after Allogeneic Bone Marrow Transplatation from HLA-Identical Siblings

This study was performed to evaluate the impact of various peri-transplant factors on transfusion requirements in 45 patients with leukemia or severe aplastic anemia undergoing HLA-matched allogeneic bone marrow transplantation(BMT).

All patients were treated in an isolated room with HEPA filtration, and the combination of cyclosporin and short-course of methotrexate was used for GVHD prophylaxis. Patients received irradiated packed red cells to maintain the hematocrit ≥30% and irradiated platelet pheresis to keep the platelet count ≥20,000/µl.

In the first month, the mean(range) number of red cells and platelet pheresis were 4.9(0-21), 26.7(8-61), respectively. On univariate analyses, pre-BMT status(high-risk : 7.94±5.14 vs standard-risk: 3.78±2.99, p=0.0076) and concurrent infection(present : 8.41±4.70 vs absent : 3.33±2.72, p=0.0005) and sex incompatibility(match : 4.67±3.72 vs female → male : 3.78±3.07 vs male → female : 9.13±5.74, p=0.0161) were significantly associated with red cell requirements in the first month. Also, high-risk pre-BMT status(32.25±16.15 vs 20.25±14.64, p=0.0l56), the presence of concurrent infection(39.35±16.42 vs 15.33±5.67, p=0.0001) and veno-occlusive disease(45.00±14.47 vs 22.00±14.49, p=0.0055) increased platelet requirements significantly after allogeneic BMT. In particular, pre-BMT disease status was found to be independently associated with transfusion requirements.

This study demonstrates that pre-BMT status does influence transfusion requirements in the first month after HLA-matched allogeneic BMT. Further studies are necessary to confirm these results and to define optimal transfusion strategies.