Chemotherapy-induced thrombocytopenia and platelet transfusion in patients with diffuse large B-cell lymphoma

Currently, the risk factors associated with chemotherapy-induced thrombocytopenia (CIT) in patients with diffuse large B-cell lymphoma (DLBCL) are still undefined. Our study aimed to analyze the effects of risk factors on thrombocytopenia and to identify the threshold for infusion platelets of CIT patients who have received platelet transfusions.

We conducted a retrospective analysis of 523 patients with DLBCL from 2011 to 2013. The clinical and demographic parameters were extracted, and the risk factors associated with CIT were analyzed. The threshold for platelet transfusions in DLBCL patients with a central venous catheter (CVC) was evaluated.

A total of 227 (43.4%) DLBCL patients had thrombocytopenia, and 63 (12.0%) had thrombocytopenia without concomitant cytopenia. We found that the choice of chemotherapy regimen was positively correlated with thrombocytopenia (P<0.001). The chemotherapy regimens most likely to result in thrombocytopenia were dexamethasone, cytarabine, cisplatin (DHAP) (92.3%), isophosphamide, carboplatin, etoposide (ICE) (89.7%), gemcitabine, dexamethasone, cisplatin (GDP) (89.7%), gemcitabine, and oxaliplatin (Gemox) (69.0%). In addition to these, high lactate dehydrogenase (LDH) (P=0.004) and Ann Arbor stage III/IV (P=0.024) were determined to be risk factors leading to thrombocytopenia. Forty patients (17.6%) had transfused platelets, and all of them were placed in the CVC. The high-threshold group (platelet count ≤20×10⁹/L had a significantly lower amount of platelet transfusions than the low-threshold group ≤10×10⁹/L. The platelet transfusion amount was 1.44±0.77 vs. 2.05±1.13 (P=0.047), respectively.

The chemotherapy regimens of DHAP, ICE, GDP, and Gemox can easily lead to thrombocytopenia. A high level of LDH in the peripheral blood and Ann Arbor stage III/IV are also associated with risk factors for thrombocytopenia. A 20×10⁹/L prophylactic platelet transfusion threshold value is safer, more effective, and thus a better choice for DLBCL patients with CVC.