The management and outcomes of patients with myelodysplastic syndrome with persistent severe thrombocytopenia: An observational single centre registry study.
Myelodysplastic syndrome
Thrombocytopenia
Tranexamic acid
Transfusion medicine
Journal
Leukemia research
ISSN: 1873-5835
Titre abrégé: Leuk Res
Pays: England
ID NLM: 7706787
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
received:
05
09
2018
revised:
07
12
2018
accepted:
10
12
2018
pubmed:
24
12
2018
medline:
17
7
2019
entrez:
24
12
2018
Statut:
ppublish
Résumé
Severe thrombocytopenia affects 10% of patients with myelodysplastic syndrome (MDS) and is associated with poor outcomes. The role for prophylactic platelet transfusions in the outpatient setting is unknown. To audit treatments, bleeding rates, and transfusion requirements of patients with MDS and persistent severe thrombocytopenia (PST) registered in a prospective MDS registry at our center. 99 (17%) of 586 total registry patients had PST; 28 were treated with tranexamic acid alone (TXA), 39 with TXA and prophylactic platelet transfusions (PROPH), 19 with PROPH alone, and 13 were untreated. Median duration of PST was 27 weeks and median overall survival was 0.9 years (95% CI 0.7-1.2). During the PST, 6% (6/99) of patients had a grade 4 bleeding event, from which 4 died. Platelet count at the time of grade 4 bleeding ranged from 2 to 19 × 10 Patients with MDS and PST had low rates of major bleeding but poor overall survival. Disparities in clinical practice likely relate to patient and provider heterogeneity and the lack of published evidence. The benefit of TXA and/or prophylactic platelet transfusions would be best evaluated by a randomized controlled trial.
Sections du résumé
BACKGROUND
Severe thrombocytopenia affects 10% of patients with myelodysplastic syndrome (MDS) and is associated with poor outcomes. The role for prophylactic platelet transfusions in the outpatient setting is unknown.
OBJECTIVE/METHODS
To audit treatments, bleeding rates, and transfusion requirements of patients with MDS and persistent severe thrombocytopenia (PST) registered in a prospective MDS registry at our center.
RESULTS
99 (17%) of 586 total registry patients had PST; 28 were treated with tranexamic acid alone (TXA), 39 with TXA and prophylactic platelet transfusions (PROPH), 19 with PROPH alone, and 13 were untreated. Median duration of PST was 27 weeks and median overall survival was 0.9 years (95% CI 0.7-1.2). During the PST, 6% (6/99) of patients had a grade 4 bleeding event, from which 4 died. Platelet count at the time of grade 4 bleeding ranged from 2 to 19 × 10
CONCLUSIONS
Patients with MDS and PST had low rates of major bleeding but poor overall survival. Disparities in clinical practice likely relate to patient and provider heterogeneity and the lack of published evidence. The benefit of TXA and/or prophylactic platelet transfusions would be best evaluated by a randomized controlled trial.
Identifiants
pubmed: 30580105
pii: S0145-2126(18)30489-2
doi: 10.1016/j.leukres.2018.12.002
pii:
doi:
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
76-81Informations de copyright
Copyright © 2018 Elsevier Ltd. All rights reserved.