Cytopenias after day 28 in allogeneic hematopoietic cell transplantation: impact of recipient/donor factors, transplant conditions and myelotoxic drugs.

Abstract

BACKGROUND:

Secondary cytopenias are serious complications following hematopoietic cell transplantation. Etiologies include myelotoxic agents, viral infections, and possibly transplant-related factors such as the intensity of the conditioning regimen and the source of stem cells.

DESIGN AND METHODS:

We retrospectively analyzed data from 2162 hematopoietic cell transplant recipients to examine the effect of these factors on overall cytopenias occurring after 28 days in hematopoietic cell transplantation.

RESULTS:

Advanced age of the patient, recipient cytomegalovirus seropositivity, unrelated donor status, human leukocyte antigen mismatch and lower doses of transplanted CD34(+) cells (≤ 6.4×10(6)/kg) significantly increased the risk of cytopenias after day 28. Non-myeloablative hematopoietic cell transplantation had protective effects on anemia and thrombocytopenia after day 28 (adjusted odds ratio 0.76, probability value of 0.05 and adjusted odds ratio 0.31, probability value of <0.0001, respectively) but not on overall or ganciclovir-related neutropenia. This lack of protection appeared to be due to the use of mycophenolate mofetil in the majority of recipients of non-myeloablative hematopoietic cell transplants. Peripheral blood stem cells did not confer protection from cytopenias when compared to bone marrow.

CONCLUSIONS:

Elderly patients appear to be more prone to cumulative toxicities of post-transplant drug regimens, but non-myeloablative conditioning, optimized human leukocyte antigen matching, and higher doses of CD34(+) cell infusions may reduce the risk of cytopenia after day 28.

• Authors: Hirohisa Nakamae, Barry Storer, Brenda M Sandmaier, David G Maloney, Chris Davis, Lawrence Corey, Rainer Storb, Michael Boeckh
• Journal: Haematologica (Haematologica) Vol. 96 Issue 12 Pg. 1838-45 (Dec 2011) ISSN: 1592-8721 [Electronic] Italy
• PMID: 21880629 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Antiviral Agents
• Mycophenolic Acid
• Ganciclovir

Topics

• Adult
• Age Factors
• Aged
• Anemia (epidemiology, etiology, prevention & control)
• Antiviral Agents (administration & dosage, adverse effects)
• Cytomegalovirus
• Cytomegalovirus Infections (drug therapy, etiology)
• Ganciclovir (administration & dosage, adverse effects)
• Hematopoietic Stem Cell Transplantation
• Humans
• Male
• Middle Aged
• Mycophenolic Acid (administration & dosage, adverse effects, analogs & derivatives)
• Neutropenia (epidemiology, etiology, prevention & control)
• Thrombocytopenia (epidemiology, etiology, prevention & control)
• Time Factors
• Tissue Donors
• Transplantation Conditioning (adverse effects)
• Transplantation, Homologous