Recombinant Human Thrombopoietin Promotes Platelet Engraftment and Improves Prognosis of Patients with MDS and AA after Allogeneic Hematopoietic Stem Cell Transplantation

Background

Poor platelet graft function (PPGF) is a common complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT), which was defined as consistent low platelet counts with recovery of the other two cell lines after transplantation. This status leads to an increased risk of life-threatening hemorrhage, frequent requirements of platelet transfusion and extended hospital stays. However, no optimal treatment has been recommended. This study investigated aspects of platelet recovery after allo-HSCT, including prognostic value and the effect of recombinant human thrombopoietin (rhTPO).

Methods

We reviewed 275 patients who received allo-HSCT in our center from January 2013 to June 2014. Of them, 135 (49.1%) patients had good platelet graft function (GPGF) and 140 (50.9%) had PPGF. The latter included 59 (21.5%) patients with primary PPGF and 81 (29.4%) with secondary PPGF. All analyses were performed using an SPSS software package.

Results

Multivariate analysis showed that male gender (P = 0.024), lower CD34+ cell count (P = 0.04), and no use of rhTPO (P < 0.001) were associated with PPGF. The 3-year OS rate of patients with PPGF (58%) was significantly less than that of patients with GPGF (82%; P < 0.001). The effect of rhTPO was further analyzed on prognosis of patients after allo-HSCT. Although no advantage was apparent when analyzing the entire cohort, for patients with myelodysplastic syndromes (MDS) and aplastic anemia (AA), rhTPO was associated with a significant survival advantage (P = 0.014).

Conclusions

Our data showed that PPGF after allo-HSCT was associated with a poor prognosis. Administration of rhTPO after allo-HSCT could promote platelet engraftment, and significantly improve the prognosis of patients with MDS and AA.