Can Pre-transplant Platelet Count Predict Acute Graft-versus-host Disease and Overall Survival in Allogeneic Hematopoietic Stem Cell Transplantation?

Background: Thrombocytopenia is a primary consequence of chemotherapy and radiotherapy in leukemia, leading to the need for blood product transfusions in patients undergoing hematopoietic stem cell transplantation (HSCT). Although blood product transfusion plays a pivotal role in the supportive care of HSCT patients, multiple transfusions can lead to alloreactive complications. Objectives: In this study, we assessed the association of pre-transplant platelet count and blood product transfusions with acute graft-versus-host disease (aGVHD), organ failure, and overall survival (OS) as outcomes following HSCT. Methods: This retrospective study was conducted on clinical records of 184 patients who underwent allogeneic HSCT (allo-HSCT). Platelet counts on admission and on the day of transplantation were analyzed using ROC analysis to determine cut-off values. The associations between platelet count, packed red cell volume, and platelet transfusions with aGVHD, organ failure, and OS were examined. Results: A platelet count >134.5×103/µL on the day of transplantation was associated with a 56% reduction in the risk of mortality (P = 0.045). An increased number of random donor platelet transfusions had a significant adverse effect on aGVHD incidence and 5-year OS (P = 0.228, 0.035). The number of packed cell units transfused was significantly associated with both increased odds of aGVHD incidence and a higher risk of mortality (P = 0.041, < 0.001). Conclusions: Pre-transplantation platelet count and blood product transfusion are associated with a higher risk of aGVHD and reduced 5-year OS following allo-HSCT. Therefore, implementing strategies to minimize blood product transfusion may help reduce the incidence of aGVHD and improve overall survival.