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

Publication Type:

Journal Article

Source:

Haematologica, Volume 96, Issue 12, p.1838-45 (2011)

Keywords:

2011, Center-Authored Paper, Clinical Research Division, October 2011, Public Health Sciences Division, Research Trials Office Core Facility - Biostatistics Service, Shared Resources, Vaccine and Infectious Disease Division

Abstract:

Background. Secondary cytopenias are serious complications following hematopoietic cell transplantation. Etiologies include use of 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 transplantation recipients to examine these factors on overall cytopenias 28 days after hematopoietic cell transplantation. Results. Advanced patient age, recipient cytomegalovirus seropositivity, unrelated donor status, HLA mismatch and lower doses of transplanted CD34+ cells (≤ 6.4x106/kg) significantly increased the risk of cytopenias after day 28. Nonmyeloablative hematopoietic cell transplantation had protective effects on anemia and thrombocytopenia after day 28 (adjusted odds ratio 0.76, probably value of 0.05 and adjusted odds ratio 0.31, probably value of <0.0001, respectively) but not on overall and ganciclovir-related neutropenia. This lack of protection appeared to be due to the use of mycophenolate mofetil in the majority of recipients of nonmyeloablative hematopoietic cell transplantation. 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 nonmyeloablative conditioning, optimized human leukocyte antigen matching, and higher doses of CD34+ cell infusions may reduce the risk of cytopenia after day 28.