Decreased transfusion requirements for patients receiving nonmyeloablative compared with conventional peripheral...

Red blood cell (RBC) and platelet transfusion requirements in patients given nonmyeloablative versus conventional peripheral blood stem cell (PBSC) transplants from HLA-matched siblings were compared. Between December 1997 and March 2000, 40 patients, aged 21 to 67 years (median 51), with hematologic malignancies underwent nonmyeloablative allografts after either 2 Gy total body irradiation alone (n = 30) or 2 Gy total body irradiation preceded by fludarabine 30 mg/m(2)/d on days -4, -3, and -2 (n = 10). All received postgrafting mycophenolate mofetil and cyclosporine. Controls included 67 concurrent patients, aged 23 to 66 years (median, 46 years), given conventional PBSC transplants following high-dose conditioning and postgrafting methotrexate and cyclosporine. Among patients given nonmyeloablative transplants, 23% required platelet transfusions compared with 100% among patients given conventional grafts (P <.0001). Further, the number of platelet units given to nonmyeloablative recipients was reduced, with a median of 0 (range, 0 to 214) compared with a median of 24 (range, 4 to 358) after conventional transplantation (P <.0001). Sixty-three percent of nonmyeloablative recipients required RBC transfusions compared with 96% of those with conventional grafts (P =.0001). The number of RBC units transfused was also reduced, with a median of 2 (range, 0 to 50) compared with 6 (range, 0 to 34) after conventional transplantation (P =.0001). High transfusion requirements before transplantation and donor-recipient ABO incompatibility increased transfusion requirements in both patient groups, though neither significantly influenced the outcome of the analysis. Neither patient age, splenomegaly at transplantation, development of graft-versus-host disease, nor posttransplantation cytomegalovirus antigenemia or cytomegalovirus disease had statistically significant influences on posttransplantation transfusions.