Randomized study of prophylactic platelet transfusion threshold during induction therapy for adult acute leukemia: 10,000/μL versus 20,000/μL

Abstract

Purpose: We designed and conducted a randomized single-institution trial comparing two common prophylactic platelet transfusion thresholds in patients undergoing induction therapy for acute leukemia. Patients and Methods: Seventy-eight patients undergoing induction therapy for acute leukemia were randomized to receive prophylactic apheresis platelet concentrates when the platelet count was either ≤ 10,000/μL or ≤ 20,000/μL. Results: There was no significant difference in the total number of bleeding episodes per patient with a median of four in the ≤ 10,000/μL arm and two in the ≤ 20,000/μL arm (25th to 75th percentiles of 2, 7 and 1, 5, respectively; P = .12). Patients randomized to the ≤ 10,000/μL arm received more platelet transfusions for bleeding [one (0, 2) v zero (0, 0); P= .0003]. In contrast, patients on the ≤ 20,000/μL arm received more platelet transfusions far prophylactic indications [10 (5, 14) v six (3, 8); P = 0.001], as would be expected, but less for bleeding. Nevertheless, the total number of platelet transfusions given to patients on the ≤ 20,000/μL arm was higher and nearly significant [11 (6, 15) v seven (5, 11); P = .07]. There were no statistically significant differences between the groups with regard to RBC transfusion requirements, febrile days, days hospitalized, days thrombocytopenic, need for HLA-matched platelets, remission rate, or death during induction chemotherapy. No patient in either group died from hemorrhage or underwent major surgery for bleeding complications. Conclusion: Giving prophylactic platelets at a threshold of ≤ 10,000/μL compared with ≤ 20,000/μL can decrease the total utilization of platelets with only a small adverse effect on bleeding, and no statistically significant effect on morbidity.